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Discussion Starter · #1 ·
Most murmurs:
Louder with squatting
  • Greater preload
  • Greater afterload
Quieter with valsalva or sudden stand
  • Less afterload
  • Less preload
The reason is that, for most murmurs, the murmur is louder when there's more blood running through a stenotic or insufficient valve.

Hypertrophic cardiomyopathy and mitral valve prolapse:
These are the ODD ONES OUT
These murmurs actually get quieter when there is more volume in the LV.
  • Quieter with squat
  • Quieter with passive leg raise
  • Louder with sudden stand
  • Louder with valsalva strain phase
  • Quieter with handgrip
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