Editor-In-Chief: C. Michael Gibson, M.S., M.D.  Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. 
Synonyms and keywords: Carvallo sign
The Mexican cardiologist José Manuel Rivero Carvallo described a sign and helpful maneuver during cardiac auscultation as an increase in the intensity of the systolic murmur of tricuspid insufficiency during inspiration.
This maneuver distinguishes it from left sided murmurs such as mitral insufficiency, which do not change with respiration.
It may be difficult to hear the change in murmur intensity during normal respiration. In that case, auscultation is performed during post-inspiratory breath holding and the loudness of the systolic murmur is compared to its loudness during post expiratory breath holding period.
The tricuspid insufficiency related murmur increases in intensity during held, deep inspiration. The murmur may also become higher pitched.
In contrast, mitral insufficiency related murmur does not increase during held, deep inspiration. It may actually decrease in intensity.
One of the explanations for the decreased intensity is the inspiratory interposition of the pulmonary appendage between the apex of the heart and the chest wall.