Marked cardiomegaly and pulmonary venous congestion Pulse oximetry discrepancy of >5% between upper and lower extremities is also suggestive of coarctation Narrow pulse pressure, if severe stenosisĢ–3/6 SEM at LUSB, radiating to left interscapular areaīicuspid valve is often associated, so may have systolic ejection click at apex and RUSBīP in lower extremities will be lower than in upper extremities Harsh SEM (2–4/6) at second RICS or third LICS, with radiation to neck and apex ± early diastolic decrescendo murmur due to AR ![]() Systolic thrill at RUSB, suprasternal notch, or over carotidsĮjection click that does not vary with respiration if valvular AS. Normal heart size with normal to decreased PVMs SEM (2–5/6) ± thrill at LUSB with radiation to back and sides S 2 may split widely with P 2 diminished in intensity Hyperactive precordium with systolic thrill at LLSB and loud S 1 ± grade 3–4/6 holosystolic regurgitant murmur along LLSB ± systolic murmur of MR at apex ± mid-diastolic rumble at LLSB or at apex ± gallop rhythmĮjection click at LUSB with valvular PS click intensity varies with respiration, decreasing with inspiration and increasing with expiration May have cardiomegaly and increased PVMs, depending on size of shunt May show cardiomegaly with increased PVMs if hemodynamically significant ASDġ–4/6 continuous “machinery” murmur loudest at LUSB ![]() Large ASD: RAD and mild RVH or RBBB with RSR′ in V 1 Wide, fixed split S 2 with grade 2–3/6 SEM at the LUSB May show cardiomegaly and increased PVMs, depending on amount of left-to-right shunting ![]() With large VSD and pulmonary hypertension, S 2 may be narrow 2–5/6 holosystolic or early systolic murmur, loudest at the LLSB, ± systolic thrill ± apical diastolic rumble with large shunt
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