Final answer:
A harsh systolic murmur along the right sternal border typically suggests a congenital heart defect like aortic or pulmonary stenosis, detected through auscultation with a stethoscope and potentially confirmed with further diagnostic imaging.
Step-by-step explanation:
When you hear a harsh systolic murmur along the right sternal border during a physical exam, the most likely diagnosis is a form of congenital heart defect, such as aortic stenosis or pulmonary stenosis. These conditions are often marked by the turbulent flow of blood through the heart, which causes the abnormal heart sounds, or murmurs, that can be heard via auscultation using a stethoscope. The murmur is graded on a scale from 1 to 6, with 1 being barely audible and 6 being very loud. In some cases, further diagnostic techniques such as phonocardiograms or auscultograms recorded with specialized electronic stethoscopes, and medical imaging can confirm the diagnosis or provide more detailed information about the heart's condition.