II. Epidemiology

  1. Ages affected: School age to adolescence (5 to 14 years old)

III. Physiology

  1. Exaggerated normal vibratory ejection sound from the pulmonary vasculature

IV. Signs

  1. Intensity: Grade I-II of VI murmur
  2. Soft, early to mid-systolic murmur at left upper sternal border (between 2nd and 3rd ribs)
  3. Crescendo-Decrescendo murmur
  4. Increased murmur in high output states
  5. Loudest when supine and decreased when upright or during breath holding

V. Differential Diagnosis

  1. Atrial Septal Defect (ASD)
  2. Pulmonic stenosis

VI. Course

VII. Resources

  1. Pulmonary Flow Murmur (USMLE Clinic, YouTube)
    1. https://www.youtube.com/watch?v=SIKxT6e7f0o

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