During bedside cardiovascular examination, various physical maneuvers and pharmacologic interventions are utilized to differentiate structural heart diseases by altering hemodynamics. Match each of the following maneuvers with its characteristic effect on the intensity of specific cardiac murmurs.
- Valsalva maneuver (strain phase)Increases the intensity of the murmur in hypertrophic cardiomyopathy and decreases the intensity of the murmur in aortic stenosis.
- Rapid squatting from a standing positionDecreases the intensity of the murmur in hypertrophic cardiomyopathy and increases the intensity of the murmur in aortic stenosis.
- Isometric handgripIncreases the intensity of the murmur in aortic regurgitation and decreases the intensity of the murmur in aortic stenosis.
- Amyl nitrite inhalationIncreases the intensity of the murmur in both aortic stenosis and hypertrophic cardiomyopathy, while decreasing the murmur of mitral regurgitation.
Cevap
Valsalva matches increased HCM/decreased AS; Squatting matches decreased HCM/increased AS; Handgrip matches increased AR/decreased AS; Amyl nitrite matches increased AS/increased HCM/decreased MR.
Each physical maneuver uniquely alters preload and afterload, predictably affecting the pressure gradients and volumes that determine murmur intensity.
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Anahtar Kavram
Hemodynamic effects of bedside maneuvers on structural cardiac murmurs