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Cardio Exam
 
 

Dynamic Manoeuvres

 
 
 
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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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