hero
Forum Guru
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i can't figure it out why handgrip (incr afterload) will decrease murmur in both cases.
Could smb explain?
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| hero
Forum Guru
Topics: 42
Posts: 557
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actually, i do understand about HOCM - incr afterload -> decr emptying -> more blood in LV =less murmur.
But why in AS? More blood in LV equals more murmur in valvular lesion.
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| Vietnamese
Forum Elite
Topics: 12
Posts: 285
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I don't remember exactly but maybe as this:
HOCM: This condition applies for tube law (Poisseuile law), then afterload effects on its murmur.
AS: This condition effects locally, not tube law, then afterload effects modestly on its murmur.
That's right?
Please other ideas.
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| janan
Forum Newbie
Topics: 0
Posts: 44
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Lets put it in simple words.in AS and HOCM, there is resistance to the outflow of left ventrile( A stenotic valve or a hypertrophied heart and the moving Mitral leaflet in HOCM).Due to this the left ventricular pressure is greater than a normal heart.All those maneours which would decrease the pressure gradient on the two sides of the resistance would decrease the murmur and viceversa.When a person clinches his fists, the peripheral arterial pressure rises and so it matches more closesly the LV pressure( hence the gradient is actually reducing).This leads to reduced murmur.
On the other hand, all those maneours which increase the pressure gradient on the two sides of the resistance will increase the murmur. This can be done either by reducing the peripheral arterial pressure or by increasing the LV retun and hence the pressure.
So the simple rule is watch the pressure gradient on the two sides of the outflow resistance.
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| hero
Forum Guru
Topics: 42
Posts: 557
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Thank you, now i got it!
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| mildus
Forum Guru
Topics: 19
Posts: 614
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nice explanation janan
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