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Valvular ejection click

It is a high pitched sound produced by the snapping open of the stenotic thickened semilunar valve.
Characteristics of ejection clicks
High pitched sounds
0.05 sec after s.
Valvular clicks are later and more audible
Pulmonary ejection click 
It is heard in Pulmonary stenosis
This is an inconstant EC better during expiration, inspiratory diastolic opening of pulmonary valve in Pulmonarystenosis, thus in inspiration no ejection click is produced
Best heard at the 2-3 LICS. Inaudible at the apex.
Special features of PEC
  • Softens with inspiration
  • PEC becomes earlier in more severe stenosis
  • PECnot usual in ASD unless associated with PAH
What is the mechanism of respiratory variation of PEC?
During inspiration the RV end diastolic pressure comes more than pulmonary artery diastolic pressure hence producing an upward movement of the valve prior to ejection of blood. Thus the partially open valve undergoes less excursion producing a soft sound.
  • Always check for the inspiratory variation of PEC
  • Always check for PEC with the patient standing up when it becomes more prominent.

Aortic ejection click
It is the valvular aortic stenosis - it is constant both during inspiration and expiration,and is  better heard over the apex and aortic area
AEC of vascular type best over aortic area.
Difference between Aortic and Pulmonary Ejection Clicks
features                Aortic election                           Pulmonic ejection
Site                        Aortic area                                  Pulmonary area
Conduction           Heard all over precordium         Localized to pulmonary area
Accentuation        No change with                           Intensity increase withexpiration
with respiration    respiration