Describe about Postural Changes in Dynamic Auscultation?
a) On sudden assumption of supine position from standing on sitting position or sudden passive elevation of both legs:
Venous return increases that increases the RV stroke volume for several cardiac cycles immediately and later on the LV stroke volume increases and consequently S, split widens. RS, and RS,, systolic murmurs of PS, TR and VSD arc augmented immediately. Later on LVS, LVS,- murmur of AS, MR and VSD are accentuated; due to increased LV end diastolic volume the
click and systolic murmur of MVP and HOCM are diminished.
b) Rapid standing or sitting up from supine position has opposite effect.
c) With assumption of left lateral dccubitus their is accentuation S,, LVS, and LVS,, OS, murmur associated with MS and MR, midsystolic click and late systolic murmur of MVP.