Pulmonic Stenosis

[thinkenergy]

Hello, I got this question from one of students whom I am tutoring:

Heart murmur that is early-systolic, best heard @ LUSB with radiation to right axilla, w/ normal peripheral pulse. What is the murmur?

My first instinct was pulmonic stenosis, but I wasn't sure at the time, so I told him that I would look it up, but could not find anything useful online.

Any help would greatly be appreciated.

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[Phloston]

Hello, I got this question from one of students whom I am tutoring:

Heart murmur that is early-systolic, best heard @ LUSB with radiation to right axilla, w/ normal peripheral pulse. What is the murmur?

My first instinct was pulmonic stenosis, but I wasn't sure at the time, so I told him that I would look it up, but could not find anything useful online.

Any help would greatly be appreciated.

Assuming no mistakes were made with what the student was asking:

Both pulmonic and aortic stenoses have mid-systolic murmurs. They're not going to be early-systolic. There is, however, an early-systolic ejection click seen with the semilunar stenoses. That click signifies the abrupt halting of the valve leaflets during their opening. The time interval between the preceding heart sound and the ejection click signifies the intensity of the murmur. In mitral stenosis, an early opening snap means the LA-LV pressure gradient is high, so the stenosis is worse. However, with AS/PS, because the murmur is instead systolic, an earlier ejection click means a less severe stenosis; this is because if the stenosis were severe, then a greater amount of time for isovolumetric contraction would be needed in order to generate sufficient pressure to open the valve.

In your case, my guess would be, that a LUSB early-systolic murmur could be a relatively minor pulmonic stenosis based on an earlier ejection click having occurred, and the normal peripheral pulsus support that the left-heart is not decompensated. Regardless, I wouldn't say that early-systolic alone would be correct. He or she would need to elaborate and mention the mid-systolic component. The only other thing I could think of is if the student meant to say diastolic for PR, not systolic for PS.