Mitral Prolapse Murmur and Squatting! - USMLE Forums
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  #1  
Old 01-12-2012
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Heart Mitral Prolapse Murmur and Squatting!

Mid systolic murmur heard in mitral valve prolapse can be decreased by squatting. Can anyone give out the explanation for the phenomenon?

Any reply is appreciated!
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Old 01-12-2012
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hmm, i know squatting is used by people with Tetralogy of Fallot as it increases TPR, thereby decreasing venous return to the heart and the pressure in the right heart, this minimizes the flow of blood from the right to the left heart through the VSD, rather it goes its usual way of up into pulmonary circulation.

now with that logic, increasing TPR will increase pressure in the left heart upon contraction as less blood will flow out against this increased pressure (decreased cardiac output), this makes the left heart fuller of blood.
and i think this masks the clicking sound of mitral prolapse.
as opposed to a valsalva maneuver which decreased venous return to the heart and the amount of blood in the left heart; with less blood in the left heart you can hear the click louder.
so i assume this squatting technique acts opposite to the valsalva maneuver?

now im no genius, in fact i regard myself much lower in intelligence and progress in prep than most people in these forums.
so please do tell me if im wrong and where i went wrong, its essentially the only way I learn lol

but thats the sense this kid would make of it.
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Old 01-12-2012
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Quote:
Originally Posted by belindalimm View Post
Mid systolic murmur heard in mitral valve prolapse can be decreased by squatting. Can anyone give out the explanation for the phenomenon?

Any reply is appreciated!
http://www.usmle-forums.com/usmle-st...t-murmurs.html

Watch this thread...hope it will clear your thoughts!!!!
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Old 07-04-2012
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squatting increses preload ...isn't it?
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Old 07-04-2012
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Quote:
Originally Posted by amit chahar View Post
squatting increses preload ...isn't it?
yeah it does increase pre-load so you have more blood in left ventricle so the bulging of the mitral valve into the lt atrrium subsides with it
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Old 07-04-2012
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Correct Answer

This is because those maneuvers that increase venous return and diastolic filling (squatting) and thereby enhance the ventricular volume, help to maintain tension along the chordae (Pathology of MVP) and to keep the valve shut. The only other murmur which, for similar reasons, responds in this paradoxical way to these common maneuvers is hypertrophic cardiomyopathy (HOCM)....
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Old 07-05-2012
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FA states MVP murmur is enhanced by maneuvers that increase TPR like squatting, hand grip.
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Old 02-28-2013
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Quote:
Originally Posted by Dr.NickRiviera View Post
hmm, i know squatting is used by people with Tetralogy of Fallot as it increases TPR, thereby decreasing venous return to the heart and the pressure in the right heart, this minimizes the flow of blood from the right to the left heart through the VSD, rather it goes its usual way of up into pulmonary circulation.

now with that logic, increasing TPR will increase pressure in the left heart upon contraction as less blood will flow out against this increased pressure (decreased cardiac output), this makes the left heart fuller of blood.
and i think this masks the clicking sound of mitral prolapse.
as opposed to a valsalva maneuver which decreased venous return to the heart and the amount of blood in the left heart; with less blood in the left heart you can hear the click louder.
so i assume this squatting technique acts opposite to the valsalva maneuver?

now im no genius, in fact i regard myself much lower in intelligence and progress in prep than most people in these forums.
so please do tell me if im wrong and where i went wrong, its essentially the only way I learn lol

but thats the sense this kid would make of it.
wouldn't squatting increase venous return?
(FA 2011 page 267)
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