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Evidence Base: Heart Sounds & Murmurs
Accuracy in Diagnosis of Systolic Murmurs
Maneuvers
This study looks at the sensitivity, specificity and predictive value of physical exam maneuvers that historically have been used in diagnosing systolic murmurs.
Two cardiologist independently examined 50 patients age 6 to 85 years of age ( mean age 45) with a systolic murmur I / VI or greater. The cardiologists were separated from the patients by a partition. An independent examiner instructed the patients in the maneuvers and supervised the implementation of them.
| Maneuvers--result in increased murmur |
Murmur |
Sens(%) |
Spec(%) |
LR+ |
LR- |
| Inspiration |
Right-sided |
100 |
88 |
8.3 |
0 |
| Valsalva |
HCM |
65 |
96 |
16.25 |
0.36 |
| Squat to stand |
HCM |
95 |
84 |
5.9 |
0.06 |
| Handgrip |
Mitral regurgitation, VSD |
68 |
92 |
8.5 |
0.35 |
| Transient arterial occlusion |
Mitral regurgitation, VSD |
78 |
100 |
|
- |
| Maneuvers--result in decreased murmur |
Murmur |
Sens(%) |
Spec(%) |
LR+ |
LR- |
| stand to squat |
HCM |
95 |
84 |
5.9 |
0.06 |
| Leg elevation |
HCM |
85 |
91 |
10.63 |
0.16 |
| Handgrip |
HCM |
85 |
75 |
3.4 |
0.2 |
HCM = hypertrophic cardiomyopathy
VSD = ventricular septal defect
|
