Murmur Maneuvers

Question 0

Hand grip

Answer 0

Increases systemic vascular resistance. Increases intensity of MR, AR, VSD; decreases intensity of AS, hypertrophic cardiomyopathy murmurs. For mitral valve prolapse, increases murmur intensity and delays onset of click.

Question 1

Inspiration

Answer 1

Increases intensity of right heart sounds (increased filling)

Question 2

Valsalva and standing

Answer 2

Decreases venous return. Decrease intensity of most murmurs except in hypertrophic cardiomyopathy (murmur increases). Decreases murmur intensity for MVP and makes click earlier.

Question 3

Rapid squatting

Answer 3

Increases venous return, increases preload, increases afterload with prolonged squatting. Decreases intensity of hypertrophic cardiomyopathy murmur, increases intensity of AS murmur. Increases intensity of MVP murmur and delays click.

Question 4

Systolic heart sounds

Answer 4

Aortic/pulmonic stenosis, mitral/tricuspid regurg, VSD

Question 5

Diastolic heart sounds

Answer 5

Aortic/pulmonic regurg, mitral/tricuspid stenosis