Right ventricular outflow tract obstruction physical examination

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Physical examination

1. A systolic murmur is often heard in the neonate.
2. A small percentage of patients have Noonan's syndrome
   • Small stature, retarded, triangle-faced shape, webbed neck, ptosis, hypertelorism, low set ears, and pectus.
   • Noonan syndrome is familial.
3. If the lesion is severe (>75 mm Hg) then there is a giant a wave secondary to the reduced compliance of the RV.
4. There is a loud systolic ejection murmur loudest in the second left intercostal space and peaking in late systole.
5. In severe forms, the pulmonic component of the second heart sound may be missing.