Diagnosis of Left-Sided Regurgitant Murmurs by Transient Arterial Occlusion: A New Maneuver Using Blood Pressure Cuffs

Abstract

Transient arterial occlusion of both arms with blood pressure cuffs inflated to 20 to 40 mm Hg above systolic pressure for 20 seconds augmented the intensity of left-sided regurgitant murmurs caused by aortic regurgitation, mitral regurgitation, and ventricular septal defect. We compared this new maneuver with handgrip exercise, squatting, and amyl nitrite inhalation in 30 patients with left-sided regurgitant murmurs and in 30 patients with murmurs not caused by left-sided regurgitation. Transient arterial occlusion increased the intensity of left-sided regurgitant murmurs more than squatting (p = 0.02) and did not statistically differ from isometric handgrip exercise and amyl nitrite inhalation in ability to identify the presence of these murmurs. A false-positive diagnosis of left-sided regurgitant murmur was less likely when using transient arterial occlusion than when using handgrip exercise (p = 0.05) and squatting (p < 0.001). Thus, transient arterial occlusion works as well as or better than other standard bedside maneuvers for diagnosing or excluding left-sided regurgitant murmurs and can be applied to all patients.