Dynamic auscultation
Dynamic auscultation involves using maneuvers to modify hemodynamic parameters during cardiac auscultation to diagnose the cause of a heart sound or murmur.
Maneuver
Valsalva, Standing
Decrease preload
Handgrip
Increase afterload
Amyl nitrite
Decrease afterload
Squating, Passive leg raising
Increase preload > Increase afterload
Hemodynamic alteration
AS, MR, VSD
Increase preload
Increase intensity of murmur: AS, MR, VSD
Decrease preload
Decrease intensity of murmur: AS, MR, VSD
Increase afterload
Decrease intensity of murmur: AS
Increase intensity of murmur: VSD, MR
Decrease afterload
Increase intensity of murmur: AS
Decrease intensity of murmur: VSD, MR
HOCM
Increase afterload, Increase preload
Decrease intensity of mumur: HOCM
Decrease afterload, Decrease preload
Increase intensity of mumur: HOCM
Mitral valve prolapse
Increase afterload, Increase preload
Decrease with late onset click
Decrease afterload, Decrease preload
Increase with early onset click
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