Only right sided cardiac sound which decreases in intensity with inspiration is:

Ans: A (Pulmonary ejection sound) Ref: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th edition, pg: 103Explanation:"The ejection systolic sound accompanying pulmonic valve disease decreases in intensity with inspiration, the only right sided cardiac event to behave in this manner. Ejection systolic sounds disappear as the culprit valve loses its pliability over time."Ref: Braunwald's Heart DiseaseHeartmurmursandsoundsChangewithinspirationChangewithexpirationMechanismExceptionRightsidedincreasesDecreases* In inspiration, there is increased blood return to right side of heartPulmonicstenosisejection systolic murmur decreases with inspirationLeft sidedDecreasesIncreases* The increased filling of the right ventricle pushes the septum toward the left ventricle compromising its filling* In inspiration, more blood stays behind in the lungs, leading to decreased venous return to the left ventricleThe click ofMVP moves closer to St and murmur may be tonger and accentuated with inspirationAlso Remember:Carvallo's sign: The pansystolic murmur of tricuspid regurgitationbecomes louder during inspiration, differentiating this from the murmur of mitral regurgitation.