Heart Murmur Auscultation Maneuvers Physical Exam

1/22/2013 4:35:42 PM
Hi,
Please share your understanding/explanations for the following maneuvers and what they are used for in the context of auscultating for heart murmurs.
- Making a fist
- Holding breath
- Deep squatting
- Any other similar maneuvers
Many thanks in advance.


1/24/2013 3:29:13 PM
valsalva------->dec. venous return (i mistakenly always thought VM involved squatting, but it doesn't, just inhale and then exhale against closed epiglottis to increase intrathoracic pressure).
squatting------>inc. venous return (by squeezing vessels)

now whats the effect of dec. VR on hemodynamics? It lowers preload, and less work being done by everything, less flow, therefore, less ejection murmur and less regurg type murmur. Obviously now squatting (which Dr. Conrad Fisher compares to squeezing of a tube of toothpaste ... the toothpaste tube being lower extremity veins) increases preload and overall workload and flow therefore increases both Regurg and Stenotic murmurs.

-- dec. in VR dec. murmur in AS,MS,AR,MR --> inc. in HOCM
-- inc. in VR inc. murmur in AS,MS,AR,MR ---> dec. in HOCM

Feel free to edit/add things. Sharing is caring. Thanks.


1/26/2013 7:20:22 AM
MEDI47802043 wrote:
valsalva------->dec. venous return (i mistakenly always thought VM involved squatting, but it doesn't, just inhale and then exhale against closed epiglottis to increase intrathoracic pressure).
squatting------>inc. venous return (by squeezing vessels)

now whats the effect of dec. VR on hemodynamics? It lowers preload, and less work being done by everything, less flow, therefore, less ejection murmur and less regurg type murmur. Obviously now squatting (which Dr. Conrad Fisher compares to squeezing of a tube of toothpaste ... the toothpaste tube being lower extremity veins) increases preload and overall workload and flow therefore increases both Regurg and Stenotic murmurs.

-- dec. in VR dec. murmur in AS,MS,AR,MR --> inc. in HOCM
-- inc. in VR inc. murmur in AS,MS,AR,MR ---> dec. in HOCM

Feel free to edit/add things. Sharing is caring. Thanks.




Yes you are absolutely correct. Remember that in HOCM and MVP (mitral valve prolapse), you see the same thing. These are the two exceptions to the rule.

Also to differentiate BTW, AS and HOCM, you would do the Valsalva.


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