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Valvular Heart Disease: Dynamic Auscultation

by Carlo Raj, MD
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    My students always ask me "Dr. Raj, an attending who asked me what it meant to clench one's fist, in the intensity of its murmur whether it is increased or decreased and I always got that question wrong and then I always went to the back of the class and I felt so that I could come up and answer me questions properly." So what we will do here as we go through dynamic auscultation as continued building up your confidence so that whatever environment that you are in that you are able to fill confident about your answer because you are walking through every aspect of the pathophys. So, up until now we have talked about inspiration, expiration, clenching of the fist and squatting and we've put that into different categories and diagnoses and it is kind of been plastered all over sporadically. So let us take all of these maneuvers and put them all together and organize it so that for one final time we have all of it in one place. Wouldn't that be nice? So, if it is respiration, and you are doing inspiration, the diaphragm is going to move downwards. It contracts. It causes then your thoracic portion to decrease and it becomes or behaves more like a vacuum. And so therefore, the sucking up blood into the right side and so, therefore, the murmurs on the right side will be increased in intensity, as simple as that. When you exercise, you are causing what? You are causing your aterials to vasodilate so that you increase amount of blood flow to the skeletal muscles that are also starving for oxygen. And then in the meantime causing venoconstriction resulting in increased venous return to the right side. And so, therefore, murmurs caused by blood flow across...

    About the Lecture

    The lecture Valvular Heart Disease: Dynamic Auscultation by Carlo Raj, MD is from the course Valvular Heart Disease. It contains the following chapters:

    • Overview of Dynamic Auscultation
    • Hypertrophic Obstructive Cardiomyopathy
    • Diagnosis
    • Overview of Changes in Murmurs
    • Summary of Dynamic Auscultation

    Author of lecture Valvular Heart Disease: Dynamic Auscultation

     Carlo Raj, MD

    Carlo Raj, MD


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