Patients with pulmonic valve stenosis usually demonstrate a pulmonic ejection sound and a harsh, diamond shaped systolic murmur whose length is directly related to the severity of the obstruction. The murmur frequently is palpable, grade IV or louder. This murmur transmits over the lung fields, especially the left. The second sounds split more widely than normal and with milder stenosis, does vary with appropriately with respiration. With severe stenosis, it is widely split with a soft P2, making the detection of wide splitting and corresponding respiratory variability more difficult. Such patients may also have a palpable right ventricular impulse due to right ventricular hypertrophy.