Pulmonary stenosis

Last reviewed: 27 Apr 2022
Last updated: 06 Nov 2018

Summary

Definition

History and exam

Key diagnostic factors

  • pathological systolic ejection murmur with or without a systolic click
More key diagnostic factors

Other diagnostic factors

  • rheumatic fever
  • dyspnoea
  • fatigue
  • chest pain
  • syncope
  • dysmorphic features of Noonan's syndrome
  • dysmorphic features of LEOPARD syndrome
  • dysmorphic features of Williams' syndrome
  • dysmorphic features of Alagille's syndrome
  • failure to thrive
  • cyanosis
  • signs of right heart failure
  • right ventricular heave
  • systolic thrill
Other diagnostic factors

Risk factors

  • black ethnicity
  • Noonan syndrome
  • LEOPARD syndrome
  • Alagille syndrome
  • Williams syndrome
  • congenital rubella syndrome
  • carcinoid syndrome
  • infectious endocarditis
  • myocardial tumours
  • external compression
More risk factors

Diagnostic investigations

1st investigations to order

  • electrocardiogram
  • chest x-ray
  • echocardiography with Doppler assessment
  • Hb and Hct
  • pulse oximetry
  • arterial blood gas
More 1st investigations to order

Investigations to consider

  • diagnostic cardiac catheterisation
More investigations to consider

Treatment algorithm

ACUTE

mild disease

moderate disease

severe to critical disease

Contributors

Authors

Edgar Tay, MBBS, MRCP (UK), MMed (Int Med), FAMS, FACC, FESC

Senior Consultant

Assistant Professor

Programme Director, Congenital/Structural Heart Disease Programme

Department of Cardiology

Department of Medicine

National University Heart Centre Singapore

Singapore

Disclosures

ET declares that he has no competing interests.

Kian Keong Poh, MBBChir (Camb), MMed, FRCP, FCCP, FAMS, FACC, FASE

Senior Consultant

Clinical Director of Research

Director of Postgraduate Education

Department of Cardiology

National University Heart Centre Singapore

Associate Professor

Department of Medicine

Yong Loo Lin School of Medicine

National University of Singapore

Singapore

Disclosures

KKP declares that he has no competing interests.

Ivandito Kuntjoro, MD, ABIM (Int.Med-USA)

Consultant

Department of Cardiology

National University Heart Centre Singapore

Singapore

Disclosures

IK declares that he has no competing interests.

James Yip, MBBS, MRCP (UK), FAMS

Senior Consultant

Department of Cardiology

National University Heart Centre Singapore

Associate Professor

Department of Medicine

Group Chief Medical Informatics Officer

National University of Singapore

Singapore

Disclosures

JY declares that he has no competing interests.

Low Ting Ting, MBBS (Singapore) MRCP (UK)

Consultant

Department of Cardiology

Programme Co-Director

Women's Heart Health Programme

National University Heart Centre Singapore

Singapore

Disclosures

LTT declares that she has no competing interests.

Acknowledgements

Dr Ivandito Kuntjoro, Edgar Tay, James Yip, Kian Keong Pho, and Low Ting Ting would like to gratefully acknowledge Dr Peter S. Fischbach, Dr Cyrus Samai, and Dr David M. Drossner, the previous authors of this monograph.

Peer reviewers

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

JC declares that he has no competing interests.

James Gnanapragasam, MBBS, MSc, FRCP, FRCPCH

Consultant in Paediatric Cardiology

Southampton University Hospitals NHS Trust

Southampton

UK

Disclosures

JG declares that he has no competing interests.

  • Pulmonary stenosis images
  • Differentials

    • Innocent murmur
    • Straight back syndrome
    • Idiopathic dilation of pulmonary artery
    More Differentials
  • Guidelines

    • Management of cardiovascular diseases during pregnancy
    • AHA/ACC 2018 guidelines for the management of adults with congenital heart disease
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer