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Cardio Exam
 
 

Positional Manoeuvres

 
 
 
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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.
  • 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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