This maneuver in studies had a sensitivity of 100% and a specificity of 80% to 88% in detecting murmurs originating in the right heart. Positive Carvallos sign describes the increase in intensity of a tricuspid regurgitation murmur heard with inspiration. Abrupt standing
Squatting, by increasing afterload and increasing preload. Squatting leads to an increase in systemic vascular resistance. An increase in systemic vascular resistance results in an increase in afterload. With HOCM, an increase in afterload will hold the obstruction in a more open configuration. This will decrease the loudness of the murmur with HOCM. Handgrip maneuver, by increasing afterload. Like squatting, this will decrease the loudness of the HOCM murmur. Valsalva maneuver. Valsalva maneuver has utility in detecting hypertrophic obstructive cardiomyopathy (HOCM). According to one study, it has a sensitivity of 65% and specificity of 96% in HOCM. Valsalva maneuver, as well as standing, decrease venous return to the heart. As a result, this decreases left ventricular filling. With HOCM, the outflow obstruction increases with a decrease in preload. This will increase the loudness of the murmur with HOCM. Post ectopic potentiation
Inhaled amyl nitrite. This is a vasodilator that diminishes systolic murmurs in left-to-right shunts in ventricular septal defects. It also reveals right-to left shunts in the setting of pulmonic stenosis and a ventricular septal defect. Methoxamine
Positioning of the patient. In the lateral decubitus position or lying on the left side. This will make murmurs in the mitral valve area more pronounced. Anatomic sources
Systolic

Aortic valve stenosis is a crescendo/decrescendo systolic murmur.
Following this is a parasternal early diastolic and mid-diastolic murmur (Austin Flint murmur). The exact cause of an Austin Flint murmur is unknown. Hypothesis is that the mechanism of murmur is from the severe aortic regurgitation. In severe aortic regurgitation the jet vibrates the anterior mitral valve leaflet. This causes collision with the mitral inflow during diastole. As such, the mitral valve orifice narrows. This results in increased mitral inflow velocity. This leads to the jet impinging on the myocardial wall.Ruptured aortic sinus (sinus of Valsalva) may present as a continuous murmur. This is an uncommon cause of continuous murmur One may hear it at the aortic area and along the left sternal border. Types and disease associations
Continuous machinery murmur, at the left upper sternal border
Classic for a patent ductus arteriosus (PDA). Signs of infants associated with serious cases of PDA are poor feeding, failure to thrive and respiratory distress. Other examination findings may include widened pulse pressures and bounding pulses. Systolic murmur loudest below the left scapula
Classic for a coarctation of the aorta. Coarctation of the aorta is narrowing of the aorta. This can occur in Turners Syndrome, (gonadal dysgenesis). Turners Syndrome is an X-linked disorder with absence of one X-chromosome. Other exam findings of coarctation of the aorta include radio-femoral delay. This is when the femoral pulse is later than the radial pulse. The pulses in the lower extremity may be weaker than those of the upper extremity. Another exam finding is of varying blood pressure in the upper and lower extremities.