Ejection click in pulmonary stenosis is:
a) Better heard in expiration
b) Better heard in inspiration
c) No change with respiration
d) None of the above
Correct answer: a) Better heard in expiration
- The ejection click in pulmonary stenosis occurs when the stiff valve opens.
- It varies with respiration and is better heard in expiration.
- It is usually seen in association with post stenotic dilatation of the pulmonary artery.
Mechanism of respiratory variation of ejection click in pulmonary stenosis
- During inspiration, the increased venous return results in an increase in right ventricular end diastolic volume
- This in turn results in pushing up of the pulmonary valve leaflets
- Hence, when the valve opens during ventricular systole, the excursion of the valve leaflets is reduced
- But during expiration, the venous return is decreased and the end diastolic volume is lower
- The valve leaflets do not get pushed up
- Hence, during systole, the valve leaflets have to move a greater distance resulting in the production of a prominent click
Read more about phasic ejection click : https://cardiophile.org/phasic-ejection-click/