Heart murmur physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Physical Examinations
Examinations of Individuals with Heart Murmurs
- Cardiac maneuvers may accentuate the murmur
- Jugular venous distension may be observed in tricuspid valve disease
- Bruits may reflect transmitted murmurs
- The carotid upstroke will be diminished in aortic stenosis (pulsus parvus and tardus)
- Peripheral pulses may be accentuated in the presence of aortic insufficiency
- Peripheral edema can be seen if there is right heart failure or constrictive pericarditis
Interventions that change murmur characteristics
- Inspiration will increase the amount of blood filling into the right ventricle, thereby prolonging ejection time. This will affect the closure of the pulmonary valve. This finding, also called Carvallo's maneuver has been found by studies to have a sensitivity of 100% and a specificity of 80% to 88% in detecting murmurs originating in the right heart [1] [2].
- Abrupt standing
- Squatting
- Valsalva maneuver. One study found the valsalva maneuver to have a sensitivity of 65%, specificity of 96% in detecting Hypertrophic obstructive cardiomyopathy (HOCM) [1].
- Hand grip
- Post ectopic potentiation
- Amyl nitrite
- Methoxamine
- Positioning of the patient. ie. positioning patients in the left lateral position will allow a murmur in the mitral area to be more pronounced.
References
- ↑ 1.0 1.1 Lembo N, Dell'Italia L, Crawford M, O'Rourke R (1988). "Bedside diagnosis of systolic murmurs". N Engl J Med. 318 (24): 1572–8. PMID 2897627.
- ↑ Maisel A, Atwood J, Goldberger A (1984). "Hepatojugular reflux: useful in the bedside diagnosis of tricuspid regurgitation". Ann Intern Med. 101 (6): 781–2. PMID 6497192.