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Summary of Dynamic Auscultation

by Carlo Raj, MD
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    00:00 flow reduced as well due to reduced pressure gradient.

    00:01 Nice little table for you to take a look at all the different maneuvers. I am just going to show you one little point for each of these lines and on your own time make sure that you are clear about how to interpret this. If you understood everything I said, this table becomes absolutely invaluable. Lying down, tell me about venous return. Increased.

    00:20 It is going to increase the murmur of every single murmur except for HOCM and tell me about MVP.

    00:30 The click is delayed, the murmur is decreased. Next, sudden standing, where is my blood? Down in the legs so, therefore, decreased venous return. So, therefore, tell me about HOCM.

    00:41 The outflow tract gets worse, increased intensity. What about MVP? When there is decreased amount of blood, the click gets closer to S1, early click long lengthen murmur. Let us move on. Squatting, increased venous return. You see the point now. You take a look at squatting and lying down, pretty similar. Valsalva, take a look at valsalva in standing up. Pretty similar. Post PVC beat, so this is a little bit more detail in terms of your premature ventricular type of issue. With handgrip you are going to increase the afterload, there is more blood that is going to be left inside my heart. Now be careful here. With stenosis of aortic and pulmonic with handgrip is about the pressure gradient and, therefore, the intensity of murmur is going to decrease. In HOCM, handgrip, more blood in my heart. So, therefore, more seperation of the outflow tract. MR, MS, and AR in those cases you are then going to increase the intensity of murmur, especially MR and AR. Amyl nitrate, now where is my blood? With amyl nitrate, what ends up happening is that you have decreased preload because you have decreased venous return. Think of nitrate as causing decreased preload due to venodilation. So, therefore, there is more pooling of your blood in your veins. Not at your heart, the veins. So if you have more blood in your veins, less in your heart, what then happens to hypertrophic obstructive cardiomyopathy? The obstruction well, it gets worsened. Increased intensity, clear? So these are things that you are paying attention to as you are going through the various maneuvers. You want to try to get a good idea of at least some of the ones that I just mentioned here for sure and anything beyond that. Well, you take a look at on your own time and you do this ever so often. You do this reinforcement and before you know it, the stuff is coming to you like its instinct. Trust me.


    About the Lecture

    The lecture Summary of Dynamic Auscultation by Carlo Raj, MD is from the course Valvular Heart Disease.


    Included Quiz Questions

    1. Standing
    2. Hand grip
    3. Passive leg raising
    4. Rapid squatting
    5. Amyl nitrate
    1. Aortic regurgitation will decrease in intensity
    2. Mitral valve regurgitation will increase in intensity
    3. Ventricular septal defect will increase in intensity
    4. Hypertrophic obstructive cardiomyopathy will decrease in intensity
    5. Mitral valve prolapse will decrease in intensity

    Author of lecture Summary of Dynamic Auscultation

     Carlo Raj, MD

    Carlo Raj, MD


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