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Most heart murmurs diminish in intensity during straining. Those derived from the right heart and pulmonary circulation regain intensity immediately after straining. Those from the left heart and systemic circulation recover only after an appreciable delay. The murmurs of patent ductus arteriosus and of mitral stenosis each showed a modified, but characteristic response. These murmur changes were correlated with recorded dynamic cardiovascular changes produced by straining.

The Straining Procedure as an Aid in the Anatomic Localization of Cardiovascular Murmurs and Sounds