When a systolic murmur is heard various maneuvers can be carried out to further delineate its etiology. Auscultation at the apex with the patient in the left lateral decubitus position, for example, is often helpful to better hear the murmur of mitral regurgitation. In our patient, after auscultation at the apex in the supine position, auscultation was carried out with the patient in the standing position and then while squatting.
Systolic murmur maneuvers (cont)
Review the effects of position change on the timing and length of the murmur. Note that in the standing position, the click and murmur move closer to the first heart sound and in the squatting position, they move closer to the second sound.