Pulmonary Valve Stenosis Does NOT Radiate to the Carotid Arteries
The murmur of pulmonary valve stenosis does not radiate to the carotid arteries—this is a distinguishing feature that helps differentiate it from aortic stenosis, which characteristically does radiate to the carotids. 1
Auscultatory Characteristics of Pulmonary Stenosis
The murmur of pulmonary valve stenosis has specific characteristics that distinguish it from left-sided lesions:
- The harsh systolic murmur is heard best at the left upper sternal border (pulmonic area), not the right upper sternal border 1
- In peripheral pulmonary artery stenosis, the systolic murmur is typically heard over the lung fields—over the back or on either lateral side of the chest 1
- These pulmonary vascular bruits are usually systolic only but may be continuous and increase with inspiration 1
- The murmur does not transmit to the neck or carotid arteries 1
Critical Distinction from Aortic Stenosis
This is a crucial clinical differentiator:
- Aortic stenosis produces a harsh systolic ejection murmur best heard at the right upper sternal border WITH radiation to the carotid arteries 2
- Aortic stenosis is also associated with a slow-rising, diminished carotid pulse (pulsus parvus et tardus) 2
- The presence or absence of carotid radiation is therefore a key physical examination finding to distinguish between these two valvular lesions
Additional Clinical Features
Other examination findings in pulmonary stenosis include:
- Wide splitting of the second heart sound due to prolonged right ventricular ejection time 1
- Signs of right ventricular hypertrophy on ECG with right-axis deviation in more severe cases 1
- The murmur intensity correlates with stenosis severity, though this relationship can be complex 1
Common Pitfall to Avoid
Do not confuse the location and radiation pattern of pulmonary stenosis with aortic stenosis. The anatomic position of these valves determines where their murmurs are best heard and where they radiate—pulmonary stenosis affects the right ventricular outflow tract and pulmonary circulation, while aortic stenosis affects the left ventricular outflow and systemic circulation, with the latter's turbulent flow transmitting into the carotid arteries 2.