Heart Maneuvers

Question 1

Valsalva

Answer 1

Exhaling against a closed glottis
Increases Intrathoracic Pressure
Decreases Venous Return
Decreases Preload
Decreases LV Volume

Increases Murmurs:
—Mitral Valve Prolapse
—HOCM

Decreases Murmurs: (Most murmurs)
—Aortic Stenosis
—Pulmonic Stenosis
—Tricuspid Regurgitation

Question 2

Standing

Answer 2

Decreases Venous Return
Decreases Preload
Decreases LV Blood Volume
Decreases Systolic Blood Pressure
Decreases Afterload

Increases Murmur:
—Mitral Valve Prolapse
—HOCM

Decreases Murmur: (Most murmurs)
—Aortic Stenosis

Question 3

Squatting

Answer 3

Increases Venous Return (via Muscle Pump)
Increases Preload
Increases LV Blood Volume
Increases Stroke Volume

Increases Afterload (Squeezing vessels)

Decreases Heart Rate

Increases Murmur (Most murmurs):
—Mitral Regurgitation

Decreases Murmur:
—Mitral Valve Prolapse
—HOCM

Question 4

Hand Grip Exercise (Isometric)

Answer 4

Increases Afterload
Decreases Stroke Volume
Increases LV Blood Volume

Increases Murmur:
—Mitral Regurgitation
—Ventricular Septal Defect
—Aortic Regurgitation

Decreases Murmur:
—HOCM

Question 5

Dynamic Exercise

Answer 5

Increases Venous Return (Muscle Pump)
Increases Preload
Increases Stroke Volume
Increases Systolic Blood Pressure

Decreases Diastolic Blood Pressure; (Metaboliic vasodilation in periphery, local regulation of peripheral pressure)

Increases Murmurs: (Murmurs due to blood flow across Normal or Obstructed valves)
—Aortic Stenosis
—Pulmonic Stenosis
—Mitral Stenosis