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/

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