What physical examination finding may indicate significant pulmonary stenosis?

The presence of a palpable thrill at the second intercostal space is an important physical examination finding that can indicate significant pulmonary stenosis. This condition narrows the outflow tract from the right ventricle to the pulmonary artery, leading to an increase in pressure and turbulence of blood flow.

When the right ventricular outflow is obstructed due to pulmonary stenosis, the resulting turbulence may create a vibratory sensation when palpating at the left sternal border, particularly in the region of the second intercostal space where the pulmonary valve is located. A palpable thrill is a clinical sign of turbulence and increased flow velocity, which is characteristic of significant obstruction such as that seen in pulmonary stenosis.

In contrast, wide pulse pressure may indicate conditions associated with volume overload or aortopulmonary shunting rather than pulmonary stenosis. Bradycardia or decreased respiratory rate are not typical findings associated with pulmonary stenosis and would suggest alternative clinical issues rather than the presence of an obstructive lesion at the level of the pulmonary valve. Thus, recognizing the palpable thrill as an indicator allows healthcare professionals to identify significant pulmonary stenosis effectively.