Should the Routine Physical Examination Include Squat Maneuvers?
Few primary care physicians or even cardiologists ask patients to squat routinely as part of the physical examination despite evidence that squatting is a quick and simple means of augmenting the cardiac examination.(1, 2, 3, 4) Characteristic hemodynamic changes may occur when patients squat or stand upright from a squatting position; squatting increases left ventricular preload and afterload, whereas rapid standing from a squatting position decreases left ventricular volume by diminishing venous return.(1, 2, 3) These hemodynamic changes manifest in clinically noticeable changes that may be observed on the routine cardiac examination. A 1988 study of the diagnostic accuracy of bedside maneuvers in the evaluation of patients with systolic murmurs found that the intensity and duration of murmurs changed for many patients, especially those with obstructive hypertrophic cardiomyopathy, after they performed a series of squats and subsequently stood upright.3
In addition to improving detection of some murmurs, squat maneuvers may be a useful way of adding important clinical information to the patient-physician encounter. Squatting can unmask inappropriate post-exercise heart rate or rhythm changes after brief exertion. Musculoskeletal problems ranging from balance disorders to myopathies may be identified if patients experience difficulty with performing squats. Specifically, screening for myopathies may be particularly relevant in those being followed on statin therapy, whereas fall risk assessment would be warranted in those on warfarin anticoagulation therapy.
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— Nona Ahankoob, Moulin Chokshi, Matthew Feinstein, Neil J. Stone, MD
This article originally appeared in the August 2011 issue of The American Journal of Medicine.
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