7/25/2019 Cardiac Murmurs and Manuevers - A Synopsis

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Physiologic

ManeuverChanges in Cardiac

ManeuversMurmurs thatINCREASE

Murmurs thatDECREASE

Inspiration Venous return to Right

heart

Venous Return to Leftheart

Most RightSided

murmurs Most Leftsided

mumurs

ValsalvaStrain Phase Preload

Afterload

MVP and HCM(LV Volume)

Most other murmur

(ow throughStenotic orRegurgitant ow)Abrupt

Standing

Suatting Preload

Afterload Most other

murmurs (owthrough Stenotic orRegurgitant valve)

MVPand HCM(

LV Volume)

Passive LegRaise

Afterload

7/25/2019 Cardiac Murmurs and Manuevers - A Synopsis

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Hand grip Afterload AR MR VSD(LV

and Aortic

Pressure)

HCM(LV Volume

AS(transvalvula

!ressure gradient)

E!e"ts of Maneuvers on H#pertrophi" Cardio$#opath#

Ph#siologi" E!e"t Change in Mur$urIntensit#

Valsalva(straining Phase)

Preload

Abrupt Standing(from sitting or su!ine

!osition)

Nitrogl#"erinAd$inistration

Sustained Handgrip Afterload

7/25/2019 Cardiac Murmurs and Manuevers - A Synopsis

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Suatting(from standing !osition)

AfterloadPreload

Passive Leg Raise Preload