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Valsalva maneuver will increase the intensity of the murmur. Going from squatting to standing will also increase the intensity of the murmur. Atrial septal defect will present with a systolic crescendo-decrescendo murmur. It is best heard at the left upper sternal border. This is the result of an increased volume going through the pulmonary valve.
The murmur in HCM increases in intensity with a standing position as well as straining with Valsalva maneuver. Mid-systolic ejection Pulmonic outflow obstruction (Pulmonic stenosis) A harsh murmur usually on left second intercostal space radiating to left neck and accompanied by palpable thrill.
For example, the Valsalva maneuver (phase II) increases the intensity of hypertrophic cardiomyopathy murmurs, namely those of dynamic subvalvular left ventricular outflow obstruction. This is due to the decreased preload in this phase, worsening the obstruction and thus accentuating the murmur. [3]
In contrast to most other heart murmurs, the murmur of mitral valve prolapse is accentuated by standing and Valsalva maneuver (earlier systolic click and longer murmur) and diminished with squatting (later systolic click and shorter murmur). The only other heart murmur that follows this pattern is the murmur of hypertrophic cardiomyopathy. An ...
On the other hand, the murmur decreases in intensity with increased preload (as in squatting) or increased afterload (as in the handgrip maneuver). [19] "Spike and dome" pulse and "triple ripple apical impulse" are two other signs that can be discovered in physical examination. [24] Pulsus bisferiens may occasional be found during examination. [25]
POTS patients experience an increase in heart rate within a few minutes of standing or sitting up. This makes it different from other conditions that generally cause a fast heart rate.
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Still's murmur is detected via auscultation with a stethoscope.It has a peculiar "musical", "resonant" or "vibratory" quality that is quite unique. [1] [2] It is generally most easily heard at the left middle or lower sternal border and the right upper sternal border, often with radiation to the carotid arteries, although other locations are common.