The hallmark of significant valvular pulmonary stenosis at the bedside is the outflow murmur, best heard at the upper left sternal edge, along with an ejection sound that may decrease with inspiration. Additional findings reflect the associated right ventricular hypertrophy with reduced ventricular compliance. These include a giant "a" wave in the jugular venous pulse and a mid-to-lower left sternal edge precordial impulse.