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Describe what is Respiration in Dynamic Auscultation ?
a) S2: Splitting of S1 is audible during inspiration.
b) Diastolic sounds and Ejection sounds: Inspiration augments RVS, and RVS, whereas LVS, and LVS, are diminished. The only right-sided event to diminish during inspiration is the pulmonary ejection click in patients with pulmonary stenosis. Respiration doesn't affect the intensity of aortic ejection sounds, except in Tetralogy of Fallot with pulmonary atresia.
c) Murmurs: Murmurs originating from right side of the heart are accentuated during inspiration. In patients with MVP, the midsystolic click and the systolic murmur occur earlier in systole and may get accentuated during inspiration as reduction in the LV cavity increases the redundancy of the mitral valve and hence increases the prolapse.
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