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Old 09-19-2011
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Stethoscope Valsalva Maneuver and Murmur of Mitral Regurgitation

Hello People, I just only have one question, why would Valsalva Maneuver decrease the Murmur of MR?
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Old 09-19-2011
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Originally Posted by emad kadri View Post
Hello People, I just only have one question, why would Valsalva Maneuver decrease the Murmur of MR?

valsalva maneuver decrease preload and so low blood volume in right heart and low volume in left so low volume across mitral valve so murmur MR soft.
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Thaaaank you so much Confident ... that makes it clear now in my head ...

and why would the leg raising increase the intensity of the murmur?
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Originally Posted by emad kadri View Post
Thaaaank you so much Confident ... that makes it clear now in my head ...

and why would the leg raising increase the intensity of the murmur?


leg rising increase the preload so increases the murmur...
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Old 09-19-2011
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This is a summary of effects of maneuvers on heart murmurs:
Maneuvers that increases venous return to the heart, like squatting & leg raising increase all murmurs except MVP & HOCM. Maneuvers that decreases venous return to the heart, like standing & Valsalva, decrease all murmurs except MVP & HOCM.
Handgrip increases after load (by compressing the arteries of the upper extremities, so it decreases Lt ventricular emptying, the heart gets more full & bigger.
Amyl nitrate is a direct arteriolar vasodilator, so it increases Lt ventricular emptying, by increasing forward flow of blood & decreases the regurgitation & back ward flow of the blood. Amyl nitrate simulates the effect of ACE inhibitors or ARBs on the heart, so any valvular disease that is treated with an ACEi/ARB will improve with amyl nitrate- improve means softer murmur.
Aortic stenosis, MVP & HOCM murmurs decrease with handgrip & increase with amyl nitrate. Aortic regurgitation & mitral regurgitation, murmurs do the opposite, ie increase with handgrip & decrease with amyl nitrate.
Both hand grip & amyl nitrate have no effect on mitral stenosis, the same for ACEi.
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Old 09-20-2011
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so that's why we give Vsodilators(ACEI/ARB) for regurgitant lesion and diuretics for stenotic lesion ..
is there easier way to know the treatment..
regarding
AS
MVP n HOCM
AR/MR
MS

:sorry::sorry:
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Old 09-20-2011
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Quote:
Originally Posted by ag2011n View Post
This is a summary of effects of maneuvers on heart murmurs:
Maneuvers that increases venous return to the heart, like squatting & leg raising increase all murmurs except MVP & HOCM. Maneuvers that decreases venous return to the heart, like standing & Valsalva, decrease all murmurs except MVP & HOCM.
Handgrip increases after load (by compressing the arteries of the upper extremities, so it decreases Lt ventricular emptying, the heart gets more full & bigger.
Amyl nitrate is a direct arteriolar vasodilator, so it increases Lt ventricular emptying, by increasing forward flow of blood & decreases the regurgitation & back ward flow of the blood. Amyl nitrate simulates the effect of ACE inhibitors or ARBs on the heart, so any valvular disease that is treated with an ACEi/ARB will improve with amyl nitrate- improve means softer murmur.
Aortic stenosis, MVP & HOCM murmurs decrease with handgrip & increase with amyl nitrate. Aortic regurgitation & mitral regurgitation, murmurs do the opposite, ie increase with handgrip & decrease with amyl nitrate.
Both hand grip & amyl nitrate have no effect on mitral stenosis, the same for ACEi.

so in short for hocm and mvp
they decrease(get better/softer) with handgrip,squat and leg raise
they increase(get worse/louder) with valsalva and standing and amyl nitrate
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