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Old 07-23-2011
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Stethoscope Maneuvers affecting Mitral Prolapse Murmur!

Hi all:

In 2011 FA errata, it says that: in the entry for mitral prolapse, change the sentence to read, "Enhanced by maneuvers that decrease venous return (standing or Valsava). but if we decrease venous return, we are supposed to decrease mitral valve prolapse as we decrease end-diastolic volume, right?

I thought that the original entry, which is : Enhanced by maneuvers that increase TPR (squatting, hand grip), in stead of the new entry, is correct.

Can someone please explain this?

Thank you!
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Old 07-23-2011
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Yes you are right, in 2010 First aid its same that by increased TPR by hand grip or squatting. Mitral prolapse murmur can be enhanced
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Old 07-23-2011
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can smebody plss xplain the concept i really get confused with this concept??
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Old 07-23-2011
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Quote:
Originally Posted by qurat21 View Post
can smebody plss xplain the concept i really get confused with this concept??
I Publish the ERRATA version for 2011, check it here ...

http://www.usmle-forums.com/usmle-st...al-errata.html
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Old 07-23-2011
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In that errata p. 250 mitral stenosis:
In the entry for mitral stenosis, the opening snap is due to an abrupt halt in leaflet motion in early systole.

in my opinion, this shall be diastole, not systole. please correct me if i am wrong.

and can you please explain why mitral prolapse is enhanced by decreasing venous return. how about increasing TPR? in my opinion, the original entry also makes sense.

thank you for your patience!
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Old 08-03-2011
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In response to the explanation of manoveurs on MVP, I checked with Bates, Goljan and UCLA murmur website and they all give the same info.

Basically, First Aid 2010 (i don't have 2011) on p.255 under Mitral Prolapse says,"enhanced by manoveurs that increase TPR". From what I can tell this is a mistake.

MVP is exactly like HCM in clinical presentation. This means that decreased preload (valsalva or standing) will INCREASE the murmur AND move it closer to S1.

The opposite is also true such that, squatting (increasing preload) will DECREASE the murmur and move the murmur closer to S2. Additionally anything that increases TPR like squatting or a handgrip will have a similar effect of decreasing the murmur and moving it closer to S2.

MVP is caused by a insufficient tension on chordae tendonae. Therefore MORE blood cases INCREASED tension and make the heart have LESS of a murmur. In other words, when the heart is FULL of blood because of increase preload then the chordae tendonae are not a problem because the volume of blood in the heart is doing the work for them. Therefore, the murmur becomes LESS and LATER.

Conversely, if you have less blood (valsalva or standing) then the cordae tendonae have decreased help and the valve will prolapse sooner.

Increase TPR means a longer phase of isovolumetric contraction. This means the heart stays full of blood longer and it the cordae tendonae have help for longer, which makes the heart seem more normal and move it closer to S2.

In summary, First Aid had a typo. It should have said that increase TPR will DECREASE intensity of the murmur.

This is how I understand it. Hope it helps someone.
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The above post was thanked by:
hishamsalahuddi (11-20-2011), luschka (02-28-2013)



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Cardiovascular-, Clinical-Signs, First-Aid, Physiology-

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