threewalkers
Forum Senior
Topics: 47
Posts: 93
|
why Ventricular septal defect and mitral regurgitation murmur don't change with squatting?（kaplan notes).
Thank you.
|
| threewalkers
Forum Senior
Topics: 47
Posts: 93
|
nobody knows?
I think kaplan may be wrong on this. I looked up other resources and all say squatting increases murmur intensity of VSD.
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
Thank u for informing us!
There are some subtle mistakes in Kaplan LN ,
In Kaplan Peds it is more than subtle !
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
I disagree that Kaplan is absolutely wrong. To understand we have to go for pathorphysiology.
Both of these murmurs are affected by :
- After load : if increases they increase ,if decrease they decrease
- Preload : if increase they increase ,if decreased they decrease
In fact squatting position there is
- Compression of femoral vessels and abdominal aorta -----------> increase in after load
- Compression of Femoral veins and IVC --------> First there is increase in venous return ------> leading to increase in preload ,then there is decrease in venous return due to persistant compression leading to Decrease in venous return :
In Squatting we can divide the effect on these murmurs in two phases :
First phase :
- Increase in after load
- Increase in preload
Result : murmurs are increased
Second phase
- Increase in after load -----> tending to increase in murmur
- Decrease in Preload -------> decreae in murmur
Result : nullification of both effects i.e No change
Best of luck
|
| threewalkers
Forum Senior
Topics: 47
Posts: 93
|
Eagle_303, you are very knowledgeable. thank you!
I agree with your explanation. However, when the question comes, which one do we choose? The increase in preload and afterload is an immediate effect and the second phase takes time to catch on. I guess the more reliable one is the first phase, isn't it?
By the way, how to distinguish MR and VSD?
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
MR and VSD are easy to recognize though both are holosystolic murmur .
MR = apical radiating to axilla
VSD = Left sternal border localized
Best of luck
|
| threewalkers
Forum Senior
Topics: 47
Posts: 93
|
The increase in preload and afterload is an immediate effect and the second phase takes time to catch on. I guess the more reliable one is the first phase, isn't it?
|
| ngaybinhyen
Forum Guru
Topics: 23
Posts: 657
|
One should look at the changes in all the phases
But yes, people are usually interested in the sudden changes like sudden changes in positions (i.e. standing up anr squatting)
|
| threewalkers
Forum Senior
Topics: 47
Posts: 93
|
thank you, ngaybinhyen and Eagle_303.
|
|
| |
| | | | | | | | | |
Similar forum topics