effect of posture
- left lateral position: accentuates murmurs of mitral valve disease
- when sitting up: accentuates aortic murmurs, ejection clicks, pericardial rub
- lying down: functional murmurs are accentuated when the patient is lying down
- Valsalva manouevre: the murmur of mitral regurgitation or aortic stenosis becomes softer during the Valsava manouevre. This manouevre causes murmurs of mitral valve prolapse and hypertrophic obstructive cardiomyopathy to become louder. If a patient squats promptly then this has the reverse effects to those occurring in the Valsalva manouevre.
- If the patient has a venous hum then this is only heard when the patient is upright. The murmur is accentuated when the patient turns his head away from the side being examined.
Last reviewed 01/2018