During cardiac auscultation, I have the patient lean forward, take a deep breath, and forcefully exhale. The combination of maneuvers causes retractions of the chest cavity, making the heart closer to the anterior chest wall. This pseudo-Valsalva maneuver also puts strain on the heart valves, bringing out any valve murmur. I call it the “Mullen maneuver.”
—James P. Mullen, MD, Spokane, Wash.

The maneuver you describe would be useful in listening for aortic stenosis or regurgitation if the patient holds his or her breath in expiration. It should be noted, however, that no single maneuver is helpful with all valvular murmurs. For example, while the Valsalva maneuver can augment a murmur of hypertrophic obstructive cardiomyopathy, it can actually soften a murmur associated with aortic stenosis or mitral regurgitation.
—Susan Kashaf, MD, MPH (99-20)

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