S1 ejection click & severe pulmonary stenosis relation is-
Correct Answer: In severe pulmonary stenosis gap reduces
Description: Ans. is 'b' i.e., In severe pulmonary stenosis gap reduceso S1 occurs due to the closure of the A. V. valveEjection click occurs due to flow of blood through the pulmonary or the Aortic valve.The ejection of the blood does not begin immediately after the closure of A- V valve.The pulmonary valve opens when the right ventricular pressure exceeds the pressure in plumonary artery. The ejection of the blood begins only after, opening of the A V valve and is preceeded by the time it takes for ventricular pressure to sufficiently exceed the Aortic and pulmonary diastolic pressure therefore there is the time interval between S1 and ejection click.o The interval between the S1 and the pulmonary ejection sound is directly related to the right ventricular isovolumic contraction time which is usually prolonged in pulmonary hypertension explaining a relative late occurrence of the ejection sound in these patients.o With increasing severity of pulmonary valve stenosis, the isovolumetric contraction shortens and the pulmonary ejection sound therefore tend to occur soon after S1.o In patient with very severe pulmonary stenosis, the ejection sound can fuse with S1 and max not he recognized.In severe pulmonary stenosis ejection click may be absent or it is very close to S1 because in severe pulmonary stenosis the increased Right ventricular pressure keeps the pulmonary' valve open before ventricular systole begins.
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