What are the effects of handgrip and squatting on Aortic stenosis ? - USMLE Forums
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Old 06-18-2011
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Question What are the effects of handgrip and squatting on Aortic stenosis ?

what effect of handgrip and squatting on Aortic stenosis


i thought both of them will increase AS

but Handgrip will decrease

and squatting will increase

KLN page 135
MTB ck page 96

please can you explain this
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Old 06-18-2011
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In terms of handgrip:

Handgrip decreases ejection of blood by increasing afterload (through the compression of the arteries of the arm) and it has no effect on venous return, thus handgrip improves (lessens) AS murmur (decreased outflow) and worsens regurgitant lesions (AR and MR), because blood is pushed back through the valve. This effect is the opposite of the vasodilation seen in amyl nitrate and ACEi (emptier LV), thus if the lesion gets better with an ACEi, it gets worse with hand grip. For HOCM, since handgrip decreases ventricular emptying (more blood in the ventricle, less emptying) it lessens the obstruction in HOCM and decreases the murmur.
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