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With isometric exercise there is an increase in sympatheltic tone with elevation of mean blood pressure, as well as an increase in heart rate. The increase in afterload favors an increase in the mitral regurgitation that intensifies the murmur in about sixty-five percent of patients.
Click on the PHONOCARDIOGRAMS to compare the loudness of the heart murmurs again.
Note: The murmur of ventricular sepetal defect also intensifies with isometric exercise but is rarely apical.