Page 109 - Clinical Pearls in Cardiology

Auscultation of the Precordium 97

Table 4: Dynamic auscultation
Maneuver Left ventricular Mechanism
cavity size
Valsalva Decreases Decreased venous
(straining phase) return
Standing Decreases Decreased venous
return
Amyl-nitrate Decreases Decreased peripheral
inhalation vascular resistance
Squatting Increases Increased peripheral
vascular resistance
Isometric Increases Increased peripheral
handgrip vascular resistance

20. What are the features of pericardial rub?
Pericardial rub is a scratching type of high pitched sound
heard in patients with pericarditis. It normally consists
of 3 components. The loudest and the most frequently
heard component is in systole (due to ventricular
contraction) and the next 2 components are in diastole
(due to ventricular filling and atrial contraction). The
pericardial rub is usually best heard along the left
parasternal area. The audibility of pericardial rub may
be enhanced by the following maneuvers:
• Applying firm pressure with the diaphragm of the
stethoscope
• By asking the patient to hold his breath at the end of
deep inspiration
• In the sitting up and leaning forward position.
A systolic pleuro-pericardial rub may be heard at
the left second intercostal space during expiration in