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    Common Murmur

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    KyWo
    This document discusses how different maneuvers and medications can affect heart murmurs. Maneuvers like squatting and leg raising increase venous return and make left-sided murmurs louder, while Valsalva and standing decrease venous return and make murmurs softer. Handgrip increases afterload and softens aortic stenosis, while amyl nitrate decreases afterload and worsens aortic stenosis. ACE inhibitors are used to treat mitral and aortic regurgitation by decreasing afterload, while mitral stenosis and aortic stenosis typically require surgery like balloon valvuloplasty or valve replacement.

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    Common Murmur

    Uploaded by

    KyWo
    144 views2 pages
    This document discusses how different maneuvers and medications can affect heart murmurs. Maneuvers like squatting and leg raising increase venous return and make left-sided murmurs louder, while Valsalva and standing decrease venous return and make murmurs softer. Handgrip increases afterload and softens aortic stenosis, while amyl nitrate decreases afterload and worsens aortic stenosis. ACE inhibitors are used to treat mitral and aortic regurgitation by decreasing afterload, while mitral stenosis and aortic stenosis typically require surgery like balloon valvuloplasty or valve replacement.

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    Common heart murmurs

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    This document discusses how different maneuvers and medications can affect heart murmurs. Maneuvers like squatting and leg raising increase venous return and make left-sided murmurs louder, while Valsalva and standing decrease venous return and make murmurs softer. Handgrip increases afterload and softens aortic stenosis, while amyl nitrate decreases afterload and worsens aortic stenosis. ACE inhibitors are used to treat mitral and aortic regurgitation by decreasing afterload, while mitral stenosis and aortic stenosis typically require surgery like balloon valvuloplasty or valve replacement.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    144 views2 pages

    Common Murmur

    Uploaded by

    KyWo
    This document discusses how different maneuvers and medications can affect heart murmurs. Maneuvers like squatting and leg raising increase venous return and make left-sided murmurs louder, while Valsalva and standing decrease venous return and make murmurs softer. Handgrip increases afterload and softens aortic stenosis, while amyl nitrate decreases afterload and worsens aortic stenosis. ACE inhibitors are used to treat mitral and aortic regurgitation by decreasing afterload, while mitral stenosis and aortic stenosis typically require surgery like balloon valvuloplasty or valve replacement.

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    Common Murmurs:

    Systolic

    Diastolic

    Aortic Stenosis

    Aortic Regurgitation

    Mitral Regurgitation

    Mitral Stenosis

    MVP
    HOCM
    An important concept to keep in mind is that maneuvers affect the volume of blood entering the heart chambers.

    Right-sided murmurs are increased with inhalation

    Left-sided murmurs are increased with exhalation


    VENOUS RETURN / PRELOAD:
    What increases venous return to the heart / Preload?

    Squatting

    Lifting the legs


    What decreases venous return to the heart / Preload?

    Valsalva

    Standing up

    Squatting Squeezes blood up into the heart Blood return to the heart.
    Valsalva Intrathoracic pressure Blood return to the heart. We can clearly observe in the table that MS, AS,
    MR, AR and VSD become louder with leg raising and squatting, except HOCM and MVP, which become softer with
    these maneuvers. On the other hand, MS, AS, MR, AR and VSD become softer with valsalva and standing, except
    HOCM and MVP, which become louder with such maneuvers.
    AFTERLOAD:
    What increases afterload?

    Handgrip
    What decreases afterload?

    Amyl Nitrate

    Handgrip Contract arms muscle Compresses arteries of the arm


    Amyl Nitrate (Vasodilator) Dilate peripheral arteries
    As we can see in the table, handgrip softens the aortic stenosis murmur by preventing blood leaving the ventricles.
    In other words, if the afterload goes up, blood cannot be ejected from the left ventricles, and the aortic stenosis
    murmur will soften.
    In Amyl nitrate, if the afterload goes down, blood can be easily ejected from the left ventricles, and finally worsening
    or making it louder.
    An important point to mention is that handgrip and Amyl nitrate have a negligible effect on mitral stenosis since both
    maneuvers do not affect ventricular filling which is important in such murmurs.
    Aortic and mitral regurgitation are worsen or louder by handgrip because this pushes blood backward into the heart.
    The same rule apply for VSD, since more blood goes from the left to the right and making it louder.But since Amyl
    nitrate has the opposite result of hangrip, then this improves both aortic and mitral regurgitation.
    On the other hand, while handgrip improves or soften the MVP and HOCM murmurs due to a large left ventricle
    caused by the increased afterload, Amyl Nitrate will result in an opposite effect which appear as an increased
    ventricular emptying due to a decreased afterload that ultimately worsen the obstruction and makes the murmur
    louder.
    DRUGS:
    Based on the table above, we can observe that mitral and aortic regurgitation can be treated with vasodilators, like
    ACEi, and ARBs.
    ACE inhibitors basically functions as the opposite of handgrip, by decreasing afterload which at the same time
    increases the forward flow of blood out of the left ventricle. In some cases when the medical therapy is not enough,
    then valve replacement is the best option.
    On the other hand, mitral and aortic stenosis are appropriately treated with surgery. Whereas mitral stenosis is
    treated with balloon valvuloplasty (or valve replacement when valvuloplasty is not an option depending on certain
    valve characteristics), aortic stenosis is best treated with valve replacement.
    Note: Even though diuretics can decrease pulmonary vascular congestion in either mitral or aortic stenosis, they are
    not as effective as balloon valvuloplasty or valvular replacement. Also important to mention, is that ACE inhibitors
    have scant effect on mitral stenosis.
    An important concept that can help us to remember the uses of diuretics and ACEIs is as follows:

    If valsalva improves the murmur, diuretics can be used.

    If Amyl nitrate improves the murmurs, ACEIs can be used.

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