sukhs
Forum Senior
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Please can anyone help me with the effect of various maneuvers like valsalva,phenyephrine,handgrip,squatting,amyl nitrate and leg raising on the murmurs?? 
something related to this is given in kaplans but i could not understand it.....
Any help will b appreciated..please help.
Thanks
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| peraspera
Forum Elite
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Hypertrophy, or thickening, particularly of the left ventricle, can result in problems with obstruction to forward flow and problems with relaxation of the left ventricle, and can thereby affect the ability of the heart to fill. With Valsalva maneuver and Amyl nitrate , there is decrease in preload ( less blood in the left ventr)-thickened left ventricle obstructs outflow, it creates murmur. When squatting or hand grip we squeeze blood up to the heart, or legs up-more blood in the heart ( increases preload), obstuction ceases, no murmur. HCM, MVP treatment with b-blockers to decrease heart rate and increase filling time to prevent obstruction. NEVER give diuretics.
Opposit with all : AS, MS,AR,MR- when we put legs up (exemple in MS),more blood goes into heart through stenotic valve, it creates murmur. AS, MS,AR,MR-improves with valsalva or standing ( decrease preload), treatment with diuretics.
there is more information on :
http://www.cincinnatichildrens.org/health/heart-e...
Edited by peraspera on 09/22/07 - 07:27 PM
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| gordon
Forum Newbie
Topics: 5
Posts: 27
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Here is an easy way to remember everything about cardiac murmur and maneuvers:
1. The are four systolic murmurs of concern: MR, VSD, AS and HOCM.
2. The are five manuevers: Remember this mnemonic:
VA-LSH ( Valsalva, AmylNitrate, Leg raising, Squatting, Handgrip-also called Phenylephrine)
3.The next step is to remember the response to maneuvers for HOCM. Please remember that out of VALSH, VA-cause increase in the murmur of HOCM, -LSH cuase decrease in the murmur of HOCM.
4. Except for V and L all the responses of AS ( aortic stenosis) are the same as HOCM. That is AS murmur too increase with A and decrease with SH. For V and L the response is opposite with HOCM, that is the AS murmur decrease with V and increase with L.
5. The response for MR and VSD is totally the opposite that of HOCM except for squatting which does not affect the murmur of MR and VSD.
Legend:
MR: Mitral Regurgitation
VSD: Ventricular Septal Defect
HOCM: Hypertrophic Obstructive Cardiomyopathy
AS: Aortic Stenosis
V: Valsalva Manuever
A: Armyl Nitrate
L: leg raising
S: Squatting
H: Hand Grip, also called Phenylephrine
Please go through a couple of times and scribble it without watching. It will work. Cheers!
I got all UW questions right for the murmurs with maneuvers. Only cost me less than 10 seconds seconds to solve one question.
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| spmvj
Forum Newbie
Topics: 3
Posts: 36
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Thanks gordon.This is an easy way to remember.
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| dermatology
Forum Elite
Topics: 30
Posts: 297
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good job gordon .... thanx for the table ... yeah it works ....
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| sukhs
Forum Senior
Topics: 19
Posts: 202
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Thank you peraspera and gordon....it really helped me..
and peraspera, i loved your display pic.....
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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Thanks guy!. That is great summary~
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