OnExam

Used to differentiate between between aortic stenosis (AS) and mitral valve (MV) prolapse or hypertrophic cardiac myopathy (HCM).

Performing the Test

  1. Securely fasten patient's gown and have them use the exam table for balance
  2. Squatting increases venous return, peripheral vascular resistance, stroke volume, and blood pressure, while standing has opposing effects
  3. Auscultate during the squatting and standing phases
  4. During squatting, an MV prolapse and HCM = delay in click, and decrease in murmur intensity
  5. AS generally will cause an increase in the intensity of murmur

References

  1. Bickley L, Hoekelman R. Bates’ Guide to Physical Examination and History Taking. Philadephia, Pa: Lippincott; 2009.