Positional Manoeuvres
Overview
- 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.
- 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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