Typical bedside findings of a patent ductus arteriosus with a large left-to-right shunt include a wide arterial pulse pressure and bounding arterial pulses, due to increased left ventricular stroke volume and rapid diastolic runoff; an enlarged and displaced left ventricular apical impulse, due to chronic volume overload; a loud continuous murmur that peaks at the second heart sound heard best at the upper left sternal edge; and a mid diastolic murmur at the apex, due to enhanced left ventricular filling.