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Dynamic auscultation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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All patients with a new murmur should undergo dynamic auscultation:

  • respiration:
    • right sided murmurs are louder during inspiration
    • expiration has the opposite effect

  • Valsalva manoeuvre:
    • this is expiration against a closed glottis

  • squatting:
    • this increases both venous return and peripheral resistance and results in almost all murmurs becoming louder
    • the exception is in hypertrophic, obstructive cardiomyopathy where the dilatation of the left ventricle partially relieves the outflow obstruction

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