Guidelines

What is the mitral maneuver?

What is the mitral maneuver?

Reduces murmur of hypertrophic obstructive cardiomyopathy and mitral valve prolapse. Valsalva maneuver. Increases intrathoracic pressure, which reduces size of left ventricle (LV); decreases venous return to the right heart and subsequently to the left heart.

What maneuvers increase murmurs?

Hand gripping increases the strength of aortic regurgitation, mitral regurgitation, and ventricular septal defect murmurs.

Why does squatting decrease MVP murmur?

Squatting from a Standing Position This maneuver will decrease the murmur of HOCM, as the increased left ventricular volume helps displace the hypertrophied interventricular septum, causing less outflow tract obstruction. This maneuver causes the click of MVP to move later in systole.

What is accentuation maneuver?

Accentuation manoeuvres Auscultate the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath to listen for radiation of an ejection systolic murmur caused by aortic stenosis.

Which murmur increases with Valsalva?

Most murmurs decrease in intensity during the Valsalva maneuver. Two exceptions are the systolic murmur of hypertrophic cardiomyopathy, which becomes louder, and the systolic murmur of mitral valve prolapse, which becomes longer and often louder.

When is Valsalva maneuver contraindicated?

Valsalva manoeuvres are contraindicated in patients with SVT associated with: acute myocardial infarction • haemodynamic instability (eg systolic blood pressure <90 mmHg) • aortic stenosis • carotid artery stenosis • glaucoma or retinopathy.

Which murmurs get louder with Valsalva?

Why does MVP get worse with Valsalva?

The Valsalva maneuver will increase the intensity of the murmur due to the decrease in preload to the right side of the heart, resulting in decreased left ventricular end-diastolic volume (the same is seen with standing from a squatting position).

What are thrills and heaves?

A thrill is a palpable murmur whereas a heave can be a sign of right ventricular hypertrophy. A thrill feels like a vibration and a heave feels like an abnormally large beating of the heart. Feel for these all over the precordium. Palpate for any heaves or thrill.

What does a heave or lift indicate?

• A lift (also heave) is an abnormal sustained, systolic. outward movement of the precordium associated. with heart failure.

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