Ejection sounds/ ejection clicks
Channel: Cardiology and Beyond
Date: 2020-04-10

Hey everyone, in this video I discuss the underlying concepts of an often ignored finding in clinical cardiology: ejection sounds/clicks. Using the methods of mind mapping and active recall questions, you should be able to master this topic in no time! 

PDF link of slides: https://drive.google.com/file/d/1D_zBUxBk4kmizJeE8SbEhzNZ11tBv1ET/view?usp=sharing

❓ Active recall questions: 
1. What does the presence of ejection sounds denote?  
2. What are the two mechanisms of ejection sounds/ejection click?
3. What happens to ejection sound when valvar stenosis is very severe?  
4. An aortic ejection sound/click is heard most commonly in which condition?
5. What does the presence of a pulmonary ejection sound denote?   
6. What is the most characteristic feature of a pulmonary ejection sound?
7. What is the mechanism of inspiratory decrease in ejection sound/click?
8. What happens normally to RVEDP on inspiration, without presence of PS?
9. What happens to the PS murmur on inspiration as compared to ejection sound/click?
10. What conditions are associated with aortic root ejection sounds/clicks?
11. What are the nonvalvular causes of pulmonary ejection sound/click?   
12. How is the severity of pulmonary hypertension related to timing of nonvalvular pulmonary ejection sound?  
13. What does the presence of ejection sound in post ASD closure patients signify?  
14. Describe acoustic characteristics of ejection sound/click?    
15. Of the valvular versus nonvalvular pulmonary ejection clicks, which one is more easily heard?  
16. Where is the pulmonary ejection sound/click best heard?
17. How to differentiate S1 from ejection sound?
18. In what body habitus is the audibility of the pulmonary ejection sound improved?
19. Where is the aortic ejection sound best heard?
20. Does the presence or absence of aortic ejection sound/click have any correlation with severity in aortic stenosis?
21. Does the aortic ejection click vary with respiration like the pulmonary ejection click does?
22. How does S2 differ with valvular ejection click versus vascular ejection click?  
23. What is the differential diagnosis of systolic ejection sound?
24. How does the click of mitral valve prolapse simulate an ejection click?
25. What helps differentiate PS from ASD having a pulmonic outflow murmur and wide splitting of S2?
26. Can an ejection sound be heard in cases of coarctation of aorta?
27. How is S4-S1 complex identified?
28. How is split S1 identified?
29. What are the clues to the presence of a bicuspid aortic valve on clinical examination?

About me:
I am Dr. Sonali, an interventional cardiologist from India. I have a special interest in cardiology academics & teaching with an emphasis on building clear concepts with clinical correlation. My channel "Cardiology and Beyond" serves to achieve the same...I hope you  find it useful in your clinical practice. 

Connect with me: 
🐤Twitter: https://twitter.com/SonaliInamdar21
📸 Instagram: https://www.instagram.com/sonaliinamdar
📩 Email: cardiologyandbeyond@gmail.com

Whiteboard app used: Explain Everything. 

References for Ejection clicks/sounds:
1. Clinical Examination in Cardiology, B.N. Vijay Raghawa Rao.
2. Clinical Methods in Cardiology, B Soma Raju.
3. Essentials of Cardiac Physical Diagnosis, Jonathan Abrams.
4. The Art and Science of Cardiac Physical Examination, N Ranganathan, V Sivaciyan, F B Saksena.
5. The 10 year old patient presenting with both pulmonary as well as aortic ejection clicks.