Overview
Dynamic manoeuvres are useful for distinguishing between hypertrophic cardiomyopathy and aortic stenosis in the presence of a systolic murmur.
Valsalva Manoeuvre
The valsalva manoeuvre reduces preload, which makes the murmur of hypertrophic cardiomyopathy louder.
How to Perform
- While auscultating the chest, ask the patient to breath out against a closed mouth and nose.
Interpretation
- The murmur of hypertrophic cardiomyopathy is louder with valsalva.
- The murmurs of aortic stenosis and mitral regurgitation are softer with valsalva.
Squatting
Squatting increases preload, which makes the murmur of hypertrophic cardiomyopathy softer.
How to Perform
- While auscultating the chest, ask the patient to squat and then stand from a squatting position.
Interpretation
- The murmur of hypertrophic cardiomyopathy is softer on squatting, and louder on standing.
- The murmur of aortic stenosis is louder on squatting, and softer on standing.
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