Physical Maneuvers for Cardiac Murmurs - WLB

Question 1

Inspiration

Answer 1

Increase VR to the right heart => Increase in Right-sided murmurs

Decrease VR to the left heart => Decreased Left-sided murmurs

Question 2

Valsalva

Answer 2

Decreased Preload/Decreased Afterload

Decreased LV volume => Increase Mitral valve prolapse and S4

All others decrease

Question 3

Abrupt standing

Answer 3

Decreased Preload/Decreased Afterload

Decrease LV volume => Increase Mitral valve prolapse and S4

Decrease all other murmur

Question 4

Squatting

Answer 4

Increased Preload/Increased Afterload

Increased most murmurs (increase flow through stenotic or regurgant valves)

Increased LV volume => decreased mitral valve prolapse and S4

Question 5

Passive leg raise

Answer 5

Increase Preload

Increase most murmurs

Decreases mitral valve prolapse and S4

Question 6

Handgrip

Answer 6

Increase afterload

Increases: Aortic Regurg, Mitral Regurg, and VSD (due to increased LV and aortic pressure)

Decreases: S4 and Aortic Stenosis