CLINICAL-DYNAMIC AUSCULTATION MANOEUVRES

SUMMARY

1. Inspiration: DIASTOLIC murmurs of the right side of the heart (TV, PV) become louder.
2. Expiration: SYSTOLIC murmurs of the left side of the heart (MV, AV) become louder.
3. Leaning forward & full expiration: AR becomes prominent.
4. Standing & valsalva strain phase: hypertrophic cardiomyopathy & MVP become prominent.
5. Squatting: AS & MR become louder.

TIP
6. Right-sided murmurs and heart sounds are louder during inspiration and any maneuvers that increase venous return, such as passive leg raising & abdominal compression.
7. Left-sided murmurs and heart sounds are louder during expiration and any maneuvers that decrease venous return, such as standing & sustained hand-grip.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].