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- Increse resistance to forward flow Hence it is smooth for blood to flow backwards hence Backward flow M