In pulmonic stenosis, obstructed right ventricular outflow causes right ventricular hypertrophy as the right ventricle attempts to overcome resistance to the narrow valvular opening.

A congenital defect, pulmonic stenosis is associated with other congenital heart defects such as tetralogy of Fallot. It’s rare among elderly people.

Pulmonic stenosis results from congenital stenosis of the pulmonary valve cusp or (infrequently) from rheumatic heart disease or cancer.

Right ventricular failure is the ultimate result of untreated pulmonic stenosis.

The patient with mild stenosis may be asymptomatic. A patient with moderate to severe stenosis may complain of dyspnea on exertion, fatigue, chest pain, and syncope. Accompanying peripheral edema may cause him discomfort.

Inspection may reveal a prominent a wave in the jugular venous pulse. If severe stenosis has progressed to right ventricular failure, the patient may appear jaundiced, with severe peripheral edema and ascites. He may also appear malnourished.

Auscultation may reveal S₄, a thrill at the upper left sternal border, a harsh systolic ejection murmur, and a holosystolic decrescendo murmur of tricuspid insufficiency, particularly if the patient has heart failure.

Palpation may detect hepatomegaly when the patient has right-sided heart failure, presystolic pulsations of the liver, and a right parasternal lift.