Clinical meaning
Heart sounds and murmurs reflect pressure gradients and flow dynamics across valves. Murmur intensity correlates with flow velocity and pressure gradient. Maneuvers that alter preload and afterload change murmur characteristics diagnostically: Valsalva reduces preload (increases HCM murmur, decreases most others); squatting increases preload and afterload (decreases HCM, increases aortic stenosis).
Diagnosis & workup
Diagnostics & workup: - Order echocardiogram for murmur characterization - Order dynamic auscultation with maneuvers - Order transesophageal echo for prosthetic valve assessment - Order cardiac catheterization for hemodynamic correlation
Risk factors: - Failure to identify pathological murmurs (aortic stenosis, mitral regurgitation) - Missed S3 gallop indicating decompensated heart failure - Inability to differentiate innocent from pathological murmurs - Not performing dynamic maneuvers for murmur characterization - Environmental noise limiting auscultation quality - Obesity and hyperinflated lungs reducing heart sound transmission