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Sdfsdynamic Auscultation

Dynamic auscultation refers to using maneuvers like the Valsalva maneuver, squatting, leg raising, handgrip exercises, and transient arterial occlusion to alter hemodynamic parameters and assist in diagnosing heart sounds and murmurs. The Valsalva maneuver decreases left ventricular preload and can help distinguish aortic stenosis from hypertrophic cardiomyopathy. Squatting and leg raising increase left ventricular preload and decrease murmurs caused by hypertrophic cardiomyopathy. Handgrip exercises and transient arterial occlusion increase afterload and intensify left-sided regurgitant murmurs. Amyl nitrate inhalation decreases afterload and reduces mitral regurgitation murmurs.

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105 views

Sdfsdynamic Auscultation

Dynamic auscultation refers to using maneuvers like the Valsalva maneuver, squatting, leg raising, handgrip exercises, and transient arterial occlusion to alter hemodynamic parameters and assist in diagnosing heart sounds and murmurs. The Valsalva maneuver decreases left ventricular preload and can help distinguish aortic stenosis from hypertrophic cardiomyopathy. Squatting and leg raising increase left ventricular preload and decrease murmurs caused by hypertrophic cardiomyopathy. Handgrip exercises and transient arterial occlusion increase afterload and intensify left-sided regurgitant murmurs. Amyl nitrate inhalation decreases afterload and reduces mitral regurgitation murmurs.

Uploaded by

richard
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Dynamic Auscultation

Dynamic auscultation refers to using maneuvers to alter hemodynamic parameters during


cardiac auscultation in order to diagnose the etiology of a heart sound or murmur.
Valsalva maneuver: The Valsalva maneuver is performed by having a patient bear down
like they are going to have a bowel movement and exhaling forcefully with the airway
closed. The hemodynamic changes that occur are complex, however the ultimate result is a
decrease in left ventricular preload.
The most important use of the Valsalva maneuver is to distinguish the murmur of aortic
stenosis from hypertrophic obstructive cardiomyopathy (HOCM) or simply to bring for the
murmur of HOCM. Aortic stenosis will soften or not change while the murmur of HOCM
becomes quite loud with Valsalva.

The Valsalva maneuver is also performed during routine echocardiographic examinations to


see if patients with grade II or worse diastolic function can decrease their left ventricular
filling pressures adequately. If the Valsalva maneuver fails to reduce the left ventricular
pressure in the setting of diastolic heart failure, then grade IV diastolic dysfunction is said to
be present which indicates a poor prognosis.
Squatting from a standing position: Squatting forces the blood volume that was stored in
the legs to return to the heart increasing preload and thus increasing left ventricular filling.
This maneuver will decrease the murmur of hypertrophic obstructive cardiomyopathy has
the increased left ventricular volume helps displace the hypertrophied interventricular
septum causing less outflow tract obstruction.

This maneuver causes the click of mitral valve prolapse to move later in systole.

Standing from a squatting position: Standing quickly from a squatting position causes
blood to move from the central body to the legs resulting in less blood returning to the heart
decreasing left ventricular preload similar to that seen with the Valsalva maneuver.
This maneuver will increase the murmur of hypertrophic obstructive cardiomyopathy and
decrease that of aortic stenosis.
This maneuver causes the click of mitral valve prolapse to move earlier in systole.
Leg raising: Passive leg raising is permed simply by raising the legs high in a patient lying
supine. This results in blood that was pooled in the legs returning to the heart increase left
ventricular filling and preload similar to squatting from a standing position.
This maneuver will decrease the murmur of hypertrophic obstructive cardiomyopathy has
the increased left ventricular volume helps displace the hypertrophied interventricular
septum causing less outflow tract obstruction.
This maneuver causes the click of mitral valve prolapse to move later in systole.
Handgrip exercise: Isometric handgrip exercises are performed by having a patient
squeeze hart repetitively. This results in increased blood pressure (similar to exercise) and
thus increased afterload. Elderly individuals may have a hard time with this maneuver and
thus transient arterial occlusion can be used instead.
This maneuver will increase the intensity of left-sided regurgitant murmurs including mitral
regurgitation and aortic regurgitation. Handgrip exercises will have no effect on the murmur
of aortic stenosis which helps distinguish the presence of coexistent mitral regurgitation
from that of the Galiveridin phenomenon.
Transient arterial occlusion: This maneuver is performed by placing a blood pressure cuff
on both arms and inflating it to 20 to 40 mmHg above the systolic blood pressure for 20
seconds. This results effectively in increased afterload.

This maneuver will increase the intensity of left-sided regurgitant murmurs including mitral
regurgitation and aortic regurgitation and is especially useful in elderly individuals who are
not able to perform adequate handgrip exercises.
Amyl nitrate inhalation: Amyl nitrate decreases left ventricular afterload by dilating the
peripheral arteries. and would decrease the murmur of mitral regurgitation.
When the afterload is decreased, there is less resistance to blood flow from the left ventricle
through the aortic valve and thus less blood regurgitates through the mitral valve,
decreasing the intensity of the murmur.
Amyl nitrate can be given via inhalation to reduce afterload for diagnostic purposes in the
cardiac catheterization laboratory (to invoke a LV outflow tract gradient in hypertrophic
obstructive cardiomyopathy patients) or as a diagnostic tool during cardiac physical
examination. Due to the advancement of echocardiography, it is not commonly used any
longer.

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