Describe Valvular PS Murmur and their characterstics?

Characteristic: Harsh crescendo-decrescendo murmur along the left sternal border and loudest at pulmonary area, conducted to left shoulder and associated with systolic ejection click. As stenosis becomes more severe, the crescendo-decrescendo systolic murmur peaks later in systole and the ejection click moves closer to S₁.

Patients with TOP physiology (VSD and PS), the murmur of PS becomes softer and shorter as the severity of PS increases. This is because more blood flows from RV to LV via the VSD than from RV to PA. This is in contrast to patients with PS with intact septum, in whom the murmur get louder and longer with increasing severity. Amy1 Nitrite inhalation softens the murmur in patients with VSD and PS but increases the murmur in patients with PS and intact septum.