What is Isonietric Exercise in dynamic auscultation ?

Can be carried out by doing handgrip exercise which is sustained over 20-30 second. It results in transient increase in SVR, BP, Heart rate, Cardiac output and LV filling pressure. LVS, and LVS, are accentuated.

Systolic murmur of AS is diminished with reduction in gradient across the valve. Murmur of AR, MR and VSD is accentuated. Systolic murmur of HOCM diminished and systolic click and murmur of MVP are delayed (as LV volume increases). This should be avoided in patient with myocardial ischaemia and ventricular arrhythmia.