In a patient with aortic regurgitation, which maneuver best accentuates the early diastolic murmur?

In a patient with aortic regurgitation, which maneuver best accentuates the early diastolic murmur?

• A. Sitting forward with breath held after exhalation
• B. Supine with no breath-holding
• C. Standing upright
• D. Left lateral decubitus position

Answer: (A)

The key idea is that the aortic regurgitation murmur is best heard when the heart is brought closest to the chest wall and the lungs are less of a barrier to sound. Sitting up and leaning forward places the aortic area toward the anterior chest and, with expiration (breath held after exhalation), the lung volume is reduced and the heart sits closer to the chest wall. This combination makes the early diastolic, decrescendo murmur louder and easier to auscultate. Other positions or maneuvers don’t optimize those same conditions. Standing upright reduces venous return and can diminish murmur intensity; a supine position and the left lateral decubitus position are more helpful for other murmurs (for example, certain mitral murmurs) but not as effective for AR.

The key idea is that the aortic regurgitation murmur is best heard when the heart is brought closest to the chest wall and the lungs are less of a barrier to sound. Sitting up and leaning forward places the aortic area toward the anterior chest and, with expiration (breath held after exhalation), the lung volume is reduced and the heart sits closer to the chest wall. This combination makes the early diastolic, decrescendo murmur louder and easier to auscultate.

Other positions or maneuvers don’t optimize those same conditions. Standing upright reduces venous return and can diminish murmur intensity; a supine position and the left lateral decubitus position are more helpful for other murmurs (for example, certain mitral murmurs) but not as effective for AR.