Dynamic auscultation
All patients with a new murmur should undergo dynamic auscultation:
- respiration:
- right sided murmurs are louder during inspiration
- expiration has the opposite effect
- Valsalva manoeuvre:
- this is expiration against a closed glottis
- this is expiration against a closed glottis
- squatting:
- this increases both venous return and peripheral resistance and results in almost all murmurs becoming louder
- the exception is in hypertrophic, obstructive cardiomyopathy where the dilatation of the left ventricle partially relieves the outflow obstruction
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