Cardiac Maneuvers Flashcards
Inspiration
Increases intensity of right heart sounds
Increased preload
Hand grip
Increased systemic vascular resistance
Valsalva (phase II) and standing
Decrease venous return
Rapid squatting
Increased venous return, preload, and afterload with prolonged squatting
Effect of valsalva (phase II) and standing on intensity of most murmurs?
Decreased intensity of most murmurs (including AS)
Decreased venous return
Effect of valsalva (phase II) and standing on intensity of hypertrophic cardiomyopathy murmur?
Increased intensity of HCM
Decreased venous return = increases stenosis
Effect of valsalva (phase II) and standing on MVP?
Decreased murmur intensity, earlier onset of click/murmur
Effect of hand grip on intensity of MR, AR, and VSD murmurs?
Increased intensity (Increased systemic vascular resistance)
Effect of hand grip on intensity of AS, HCM murmurs?
Decreased intensity (Increased systemic vascular resistance)
Effect of hand grip on MVP?
Increased murmur intensity, later onset of click/murmur
Increased systemic vascular resistance
Effect of rapid squatting on intensity of hypertrophic cardiomyopathy murmur?
Decreased intensity of HCM
Increased venous return, preload, and afterload = decreases stenosis
Effect of rapid squatting on intensity of AS murmur?
Increased intensity (Increased venous return, preload, and afterload)
Effect of rapid squatting on MVP?
Increased murmur intensity, later onset of click/murmur
Effect of respiration
Right sided murmurs (TR) increase with inspiration due to increased venous return to the right heart
Effect of abrupt standing
Most murmurs diminish in intensity due to reduced venous return and subsequently reduced R/L ventricular diastolic volumes
Murmur of HCM becomes louder
Effect of squatting
Most murmurs become louder (also with passive leg raising)
Murmur of HCM becomes softer
Effect of valsalva maneuver
Most murmurs decrease in intensity
Murmur of HCM becomes louder
Effect of sustained hand grip
Most useful in differentiating AS from MR
AS = decreased intensity
MR = increased intensity
Respiration physiology
Venous return to RV increases during inspiration resulting in increased volume
Venous return to LV decreases during inspiration resulting in decreased volume
Primarily alters intensity of murmurs that originate from right side of heart
Abrupt standing physiology
Decreases venous return to heart = decreases RV and LV diastolic volumes and SVs
Can lead to a fall in arterial pressure and a reflex increase in HR
Valsalva maneuver physiology phase 1
Onset = transient increase in LV output
Valsalva maneuver physiology phase 2
Straining = decrease in venous return, RV and LV volumes, SVs, MAP, and PP
Associated with reflex increase HR
Valsalva maneuver physiology phase 3
Release = further reduction in LV volume
Valsalva maneuver physiology phase 4
Increase in stroke volume and arterial pressure
Reflex slowing of HR (overshoot)
Which phase of valsalva is most useful and practical for differentiating heart sounds?
Phase 2 = straining
Hand grip physiology
Increase in systemic vascular resistance, arterial pressure, CO, and LV volume/filling pressure
Expiration
Increases return to left heart
Effect of inspiration on TR?
Enhanced (increased RA return)
Effect of squatting and hand grip on MR?
Enhanced (increased TPR)
Effect of hand grip on VSD?
Enhanced (increased afterload)
Effect of midsystolic click in MVP with maneuvers that decrease venous return (standing, Valsalva)?
Decreased volume = occurs EARLIER
Effect of midsystolic click in MVP with maneuvers that increase venous return (squatting)?
Increased volume = occurs LATER
Effect of hand grip on AR?
Increased intensity
Effect of vasodilators on AR?
Decreased intensity
Effect of expiration on MS?
Enhanced (increased LA return)
