Ejection click in pulmonary stenosis – Medicine MCQ

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/