Aortic regurgitation

[Jenny_94]

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During physical examination of a patient with Aortic regurgitation it is said that the murmur is best heard at end expiration, leaning forward. What is the mechanism? I mean, what does leaning forward have to do with AR?

 

[Jabbed]

The heart physically comes closer to the chest wall.

 

[Jenny_94]

That is true. But then, does that work in every other valvular diseases? Or only AR?

 

[PaxRoma]

At end expiration, more blood volume return to left heart. Increased blood volume in LV means more regurgitant in AR -> louder noise.
Pericarditis friction rub can also be best heard when leaning forward.

 

[Transposony]

Wondering what @Instatewaiter would say about this.

 

[Instatewaiter]

Wondering what @Instatewaiter would say about this.

It does a few things.

First, you are using your core muscles and this increases afterload therefore making the regurgitant fraction (and volume) worse.

Second, at end expiration your HR slows, making diastole longer and increasing not only the time of regurgitation but the regurgitant volume worse.

 

[Jenny_94]

I understand now. Thanks a lot!