sofianee
Forum Junior
Topics: 3
Posts: 41
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ayeshah_l wrote:
can anybody plz explain the effect of following maneuvers on systolic murmurs. I am having a tough time remembring it. I know the increases and decreases, but i want to know y thats happening. thanks for ur time.
1. valsalva
2. Phenylephrine handgrip (by the way what is it? )
3. Squatting
4. Amyl Nitrate
5. Leg raising
their effect on murmurs in
1. Aortic stenosis
2. HOCM
3. VSD
4. MR
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| sofianee
Forum Junior
Topics: 3
Posts: 41
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AS,AR,MS,MR & VSD : Amyl Nitrate, Valsava & Handgrip: decrease
Leg rising & squating: worsen
HOCM & MVP :...............................................: worsen
:................................: decrease
Attached Files:
Admission lis1.doc (21 KB, 18 downloads)
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| Vai
Forum Elite
Topics: 30
Posts: 195
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I think if you learn this other than logic you going to forget, try to follow me and please correct me if I'm wrong.
[font="Arial, Helvetica, sans-serif" size=3">-more blood thru orifice result more intense murmur
- valsalva is the opposite to leg rising
leg rising more blood for heart, valsalva less blood for heart thus :VSD, MR, AR, AS, MS decrease with valsalva and increase with leg rising.
- phenylephrine or handgrip(same effect) is the opposite to amyl nitrite
phenylephrine increase after load, harder for blood to exit from heart thus less blood thru Ao valve result AS decrease; small amount of blood exit result more blood for the heart to regurgitate thus VSD, MR, AR increased. Amyl Nitrite make the opposite, easy for blood to exit(decrease after load) result more blood thru Ao valve less for the heart to regurgitate.
MS is relative the same with AS small amount of blood in left V(amyl nitrite) easy to pass a big quantity thru mitral and revers
MVP & HOCP are the same in respons
MVP: a left V full of blood result in short range of movement of prolapsed valve result in decrease murmur( leg rising, phenylephrine) and increased with empty ventricle(amyl nitrit, valsalva) [/font]
Edited by Vai on 06/18/05 - 02:44 AM
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| chemamr
Forum Hero
Topics: 703
Posts: 4,462
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 WOW!!!, well done Vai, very good explanation. Thank you.
By the way, what residency do you want to make? 
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| ayeshah_l
Forum Elite
Topics: 29
Posts: 284
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Vai all i can say is WOW !! excellent explanation. For the first time i got it!!!!! U r right, once u grasp the concept, it becomes easy.
Thankyou so much.
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