A patient presents with a systolic murmur. The differential is wide.  Let’s use augmentation maneuvers to narrow the differential diagnosis.


Inspiration – Inspiration was found to increase right-sided heart murmurs with 100% sensitivity and 88% specificity (Lembo, NEJM, 1988).


Transient arterial occlusion by blood pressure cuff inflation increases the regurgitant murmurs of aortic regurgitation, mitral regurgitation, and ventricular septal defect.  Hand grip is sometimes taught for this purpose, but to the extent that it represents exercise, it can increase flow murmurs as well.


Most of the skills in auscultation come from a combination of knowledge and experience.  A good website for learning basic heart sound pathologies is


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s