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Cardio Exam

Positional Manoeuvres

July 1st, 2020


Listening for cardiac murmurs in different positions as well as in inspiration and expiration can be used to narrow down the potential cause for the murmur.

Inspiration & Expiration

Inspiration and expiration can be used when assessing for murmurs in order to localise a murmur to the left or right side of the heart.
  • How to Perform

  • Ask the patient to take a deep breath in and hold it. Ask them to then take a deep breath out and hold it.
  • Interpretation

  • Right-sided murmurs (tricuspid / pulmonary) are louder on inspiration.
  • Left-sided murmurs (aortic / mitral) are louder on expiration.
  • The fourth heart sound (S4) is best heard during inspiration.

Left Lateral Position

Asking a patient to lie in the left lateral position is a useful manoeuvre for identifying mitral stenosis.
  • How to Perform

  • Ask the patient to roll over and lie in the partial left lateral decubitus position.
  • Left Lateral Position
The third heart sound and the murmur of mitral stenosis are made louder in the left lateral position.

Sitting Forward

When assessing for cardiac murmurs, asking a patient to sit forward can greatly assist in the diagnosis of aortic and pulmonary pathology.
  • How to Perform

  • Ask the patient to lean forward and hold their breath in full expiration.
  • Significance

  • Pericardial rub and the murmurs of aortic and pulmonary regurgitation are made louder on leaning forward after a forced expiration.
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