Which maneuver increases the intensity of the aortic regurgitation murmur?

• A. Valsalva maneuver
• B. Standing
• C. Squatting
• D. Sitting and leaning forward

Answer: (D)

The main idea here is how body position affects how loudly a diastolic murmur is heard. Aortic regurgitation produces a high-pitched blowing sound best heard along the left sternal border during diastole, and it becomes louder when the heart is most easily transmitted to the chest wall. Sitting up and leaning forward brings the left ventricle and aorta closer to the chest wall and, when the patient exhales, enhances the transmission of the regurgitant jet to the stethoscope. That combination makes the diastolic murmur noticeably louder, which is why this maneuver is the best choice.

Maneuvers that reduce preload, like Valsalva or standing, tend to dampen murmurs by lowering the LV stroke volume and the driving pressure behind the regurgitant flow. Squatting increases preload and afterload but does not position the heart as optimally for auscultation of AR as sitting up and leaning forward, so it isn’t as reliable for increasing the murmur’s intensity.