a u s c u l t a t i o n    t u t o r
Early-systolic ejection sounds

The intensity of the murmur at any given point of ejection is dependent upon flow at that specific time. Thus, if flow is
highest in early ejection, the intensity of the murmur will peak early. In contrast, the murmur will peak late if flow is
higher during the later phase of ejection. Systolic clicks are classified as ejection or nonejection clicks. Systolic
ejection clicks occur in early systole and may result from either the abrupt opening of the semilunar valves or the rapid
distention of the proximal aorta or pulmonary artery at the onset of ejection. Systolic ejection clicks may be aortic or
pulmonary in origin. The two are difficult to differentiate. In fact, it is frequently difficult even to separate a systolic
ejection click from a split first heart sound or an atrial gallop sound (S4) followed closely by S1.
t h e     h e a r t
Normal Cardiac Cycle
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