heart - bedside maneuvers

Question 1

Supine to standing - describe:
venous return
carotid sinus baroreceptor activity
cerebral blood flow

Answer 1

venous return
carotid sinus baroreceptor activity
cerebral blood flow
(All decrease)
Decrease preload

Question 2

Inspiration

Answer 2

Increase venous return to RA

inc intensity of right heart sounds

Question 3

Hand grip

Answer 3

(increase afterload)

Inc intensity of MR, AR, VSD

Question 4

Valsalva

Answer 4

Decrease preload
(inc pressure in chest signals to body that less blood should go to the heart aka not enough room for more expansion)
(Dec intensity of most murmurs -esp hypertrophic conditions)

Question 5

Rapid squatting

Answer 5

Increase venous return
Decrease preload
Increase afterload
(increase AS murmur intensity)

Question 6

Handgrip maneuver does what to murmurs in hypertrophic cardiomyopathy?

Note: murmur is b/c the interventricular septum hypertrophies out of proportion to the rest of the heart, so it bulges into the LV. When the mitral valve closes, it ends up hitting the IV septum.

Answer 6

Inc afterload - dec murmur.
Harder for the blood to leave the heart/more blood ends up in the LV bc it is harder to leave (aka increases the preload). If there’s more blood in the LV, then its going to expand and pushes the IV septum away from the mitral valve, hence the murmur decreases
Note: maneuvers that inc preload or afterload will dec murmur intensity by inc LVEDV and lessening outflow tract obstruction

Question 7

What are mm stores of creatine phosphate, myoglobin o2, and ATP immediately after exercising has begun?

Answer 7

Inadequate O2 –> dec creatine phosphate, myoglobin O2 and ATP

Question 8

excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration.

Answer 8

Hypercapnia -eg can cause mental status change in COPD exacerbation

Question 9

Sudden standing does what?

Answer 9

Decreases preload

Question 10

Passive leg raise has what physiologic effect? Change in HCM murmur?

Answer 10

inc preload

Dec murmur

Question 11

End expiration does what?

Answer 11

Decreases lung volume, bringing heart closer to the chest wall.