Murmur decrease with Valsalva and squatting! - USMLE Forums
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  #1  
Old 07-15-2012
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Heart Murmur decrease with Valsalva and squatting!

70 years old woman is on 2 anti hypertensive medications and cholesterol lowering statin. She quit smoking 5 years ago after smoking for 35 years. she is complain of chest pain. Physical exam: thrill palpated in the sternal notch. An S4 and mid-systolic murmur loudest in second and third right interspace. The murmur decrease with Valsalva and squatting and increase with standing. Which is the diagnosis?

1- Aortic regurgitation
2- Aortic stenosis
3- Mitral regurgitation
4- Mitral stenosis
5- Pulmonary regurgitation
6- Pulmonary stenosis


EXPLAIN????????
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Old 07-15-2012
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aortic stenosis ---

here are the hints in the question stem

S4 -- indicates LVH
systolic murmur -- so either AS or MR (systolic murmurs0

2-3rd right intercostal space --- aortic area
valsalva -- decreased preload hence decreased murmur (decreased blood flow thru stenotic valve)

squatting -- increased preload hence increased murmur (increased flow thru stenotic valve)

70 years old ---- probably age related aortic stenosis
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Old 07-15-2012
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Everything else fits with AS except:
Quote:
The murmur decrease with Valsalva and squatting and increase with standing
standing>>>>>>decreased preload hence murmur should decrease

squatting >>>> increased preload hence the murmur should increase
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Old 07-15-2012
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Quote:
Originally Posted by Novobiocin View Post
Everything else fits with AS except:


standing>>>>>>decreased preload hence murmur should decrease

squatting >>>> increased preload hence the murmur should increase
yup. valsalva and standing shud basically go together as they have the same effect of decreasing preload
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yes you guys are both right.
but the question describe different finding????????????????
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Old 07-15-2012
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Quote:
Originally Posted by alex85 View Post
The murmur decrease with Valsalva and squatting and increase with standing. Which is the diagnosis?
the q says iy's decrease with squatting?????????????
and increase with standing??????????????????
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