dear forum,need help.please explain(ejectionclick) - chocolat

[ArchivalUser]

hi all,
could you please tell me why pulmonary ejection click is heard better during expiration and no click is produced during inspiration while, in aortic ejection click it is constant during both phases of respiration?
thanks a lot.

[ArchivalUser]

OKAY here we go...........As you might know that during inspiration, the intrathoracic pressure is negative (suction of air into the lungs), and abdominal pressure is positive (compression of abdominal organs by diaphragma). This makes a pressure gradient between the infra- and supradiaphragmatic parts of v. cava inferior, "PULLING" the blood towards the right atrium....

So in scenarios like Pulmonary stenosis,this evokes hypertrophy of the right ventricle, stiffening that chamber. When blood is drawn into the right ventricle from the right atrium as per above said explanation during inspiration, the thickened right ventricle does not distend normally, so pressure in that chamber rises, and the pulmonary valve is PARTIALLY opened,means not CLOSED as it is supposed to be in P.Stenosis,,,,so Because the pulmonary valve is partially open when the right ventricle contracts, its excursion is less,as valve was already half way opened now,,hence the ejection click associated with its maximal opening is softer as ejection click is loud when there is VERY high excursion of the valve!!So it all occurs in inspiration,and during expiration we can hear better loud pulmonary ejection because now pooling of the blood in RA,and eventually in RV decreases,so which decreases RV strain and hence less pressure,so the pulmonary valve OPENS without preexisting half excursion of the valve,which produces more louder click...

Aortic valve clicks don't alter with inspiration so no changes are seen with inspiration,which eventually produces no changes in expiration as well.

I hope I have cleared this concept..

It was a very IMPORTANT thing that you asked,i appreciate your question highly.

Thanks.

[ArchivalUser]

dear the_dumb,
thanks a lot for the explanation...i really understood what u have explained and am very grateful for your help.

[ArchivalUser]

For simplicity just remember it that way

In inspiration Pulmonary valve in P Stenosis is already partially opened,which is due to high RV strain and pressure as in inspiration blood get pulled more towards RA,RV...so as we know ejection clicks are loudest when the valves open from zero point(not related to High pressure),so hence ejection click is not loudest as here valve is opening from mid way...so sound loudness automatically would be lesser in inspiration which eventually lead to partial opening of the valve due to high pressures during this event as compared to expiration.

[ArchivalUser]

really appreciate your help