Murmurs and Maneuvers Made Easy

PRELOAD Maneuvers:-
  • Maneuvers that INCREASE PRELOAD or Venous return :- Leg raise / Squatting
  • Maneuvers that Decrease Preload or venous return :-Standing / Valsalva
  • ALL MURMURS increase in intensity [= Worsen] with INCREASE in Venous return[=blood volume inside heart] EXCEPT HOCM and MV Prolapse. (They reduce in intensity[=Improve]).

AFTERLOAD maneuvers :-
  •   Hand grip= Increases After load.
[This is like squatting of upper limb but since upper limb unlike leg has very small amount of blood- this doesn't affect venous return only effect- increase in AFTER LOAD.]
  • AFTER LOAD maneuvers [unfortunately] DO NOT HAVE uniform rule [like PRELOAD manuevers].
  • Consider Murmur groups in FORWARD FLOW AND BACKWARD FLOW MURMURS.
             Backward flow - Aortic Regurg/ Mitral regurg/ and VSD
             Forward flow - MS /HOCM and MVP

  •  WITH HANDGRIP-
  1. Increse resistance to forward flow Hence it is smooth for blood to flow backwards hence Backward flow MURMUR intensity INCREASES[=Worsens] and Forward flow
    Murmur intensity Decreases [= Improves] [least effect on MS][Observable effect on AS]
Turbulence & Murmur :-
  • More pressure diff across valve- More murmur. 
  • Start equalizing pressure on two sides of valve- reduce turbulence - reduce intensity of Murmur.

 Source:  Thank You,  AkAk65946855 

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