DrVirgo
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What is the effect of squatting on the intensity of the following murmurs:
(increase, decrease or no change), and please explain why.
1. Aortic Stenosis
2. HOCM
3. Mitral Regurg
4. VSD
Thanks 
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| webjeee
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1. Aortic Stenosis -- increase or decrease
2. HOCM ----------- decrease
3. Mitral Regurg ----no change
4. VSD---------------no change
I had the same question.
but I think the key here to the question is thinking about the dual effects that squatting will impose ( a little bit different from handgrip)
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| dr.wad
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1) AS >>>> increase
2) HOCM>>> decrease
3)MR>>> increase
4)VSD>>> increase
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| DrVirgo
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Squatting (or Leg Raising while supine) will increase blood to the heart.
So WHY does leg raising increase the intensity of VSD and MR, but with squatting, it has NO effect on VSD and MR murmurs?
As for Aortic Stenosis, squatting should increase the murmur. (Kap says "increase or decrease") -Can anyone explain this... When/why would it DECREASE???
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| webjeee
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as I said squatting is different from handgrip and leg raising as well
handgrip only increases the afterload, very little preload, because the forearm hold a little blood.
leg raising is a passive action, no muscle contraction or squeezing at all, so preload increases only, a little bit afterload increase, because altitude increases.
squatting increases both by pump back blood and increase the peripheral resistance.
So, for aortic stenosis or something else, which depends on both afterload and preload change, it could be increase or decrease, depends on the balance of the two factors. If blood back contributes more than peripheral resistance change, then increases. vise versa.
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| DrVirgo
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Sorry, I'm still a bit confused on this:
With Squatting:
Mitral Regurg ----no change
VSD---------------no change
Squatting should increase preload, so these murmurs shoudl increase!!!
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| pinku
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webjee is absolutely correct, there is no change in MR murmur because there is equal increase in the resistence to frwd and bcwd flow and when it comes to hocm an increase in pre load or after load will decrease the intensity of the murmur so either way it should decrease, i was bit confused when i was reading the kaplan about AS, it dosent sound feasible?????????
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