Pathophysiology
Clinical meaning
Heart sounds and murmurs reflect pressure gradients and flow dynamics across valves. Murmur intensity correlates with flow velocity and pressure gradient. Maneuvers that alter preload and afterload change murmur characteristics diagnostically: Valsalva reduces preload (increases HCM murmur, decreases most others); squatting increases preload and afterload (decreases HCM, increases aortic stenosis).
