DRamarnath
Forum Junior
Topics: 12
Posts: 41
|
why is there increased systolic murmur in hypertrophic obstructive cardio myopathy during valsalva maneuver and when given amylnitrate and also why it is decreased in squatting and hand fist position any explanation will be appreciated
___________________
fucking world sucks
|
| deja_vu
Forum Senior
Topics: 4
Posts: 208
|
Valsalva decreases preload (venous return) by increasing intrathorasic pressure. Amylnitrate does that by venodilatation. Squatting and hand fist position increases preload and afterload by compressing veins and arteries.
In HOCM, decrease in preload leads to earlier emptying and thereby increase in gradient across LV outflow tract and the murmur. vice versa. Increase in afterload helps to decrease the gradient. (Gradient is the pressure difference between LV and system. So more the afterload (pressure in system) , less the gradient.
[try to imagine a HOCM heart with thick septum and systolic ant. motion of mitral septum generating systolic outflow gradient. If there's less blood in it, more easity the outflow gets narrowed in systole. If more blood, it stays inflated like balloon and no obstruction]
Hope it makes sense. Correct me if anything.
___________________
GOAL: NEURO-2009, Creds: 2007 Grad, Need H1B/J1, Doing MPH, Step1:266, Step2CK:272, CS: Awaiting results, USCE (O'ship) & USLORs: + (Neuro), Trying to get into a clinical research in INR.
|
| DRamarnath
Forum Junior
Topics: 12
Posts: 41
|
hi dejavu , what u mean to say is less blood in heart more easy to contract and so the murmur is more acoustic like less air in a ball is more easy and more spacious it will be to press and even more faster am i correct , i dont get why you have said about mitral septum here what is that
___________________
fucking world sucks
|
|
| |
| | | |
