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Zorluk: OrtaCardiovascular System

Match each of the following dynamic auscultation findings with the most likely underlying structural or valvular pathology.

  • A harsh crescendo-decrescendo systolic murmur at the left lower sternal border that becomes louder with the Valsalva maneuverHypertrophic cardiomyopathy
  • A mid-systolic click followed by a late systolic murmur at the apex that occurs later in systole with rapid squattingMitral valve prolapse
  • A harsh crescendo-decrescendo systolic murmur at the right second intercostal space that decreases in intensity with the Valsalva maneuverAortic stenosis
  • A holosystolic murmur at the apex that radiates to the axilla and increases in intensity with sustained handgripMitral regurgitation

Cevap

The dynamic auscultation findings accurately map to hypertrophic cardiomyopathy (louder with Valsalva), mitral valve prolapse (later with squatting), aortic stenosis (softer with Valsalva), and mitral regurgitation (louder with handgrip).
Each maneuver predictably alters cardiac hemodynamics (preload and afterload), which changes the intensity or timing of murmurs depending on their underlying anatomical mechanism.

Adım Adım Çözüm

1
Evaluate the murmur that becomes louder with the Valsalva maneuver.
The Valsalva maneuver decreases preload. A murmur that intensifies with decreased left ventricular volume is characteristic of hypertrophic cardiomyopathy.
Decreased left ventricular volume exacerbates the dynamic outflow tract obstruction.
2
Evaluate the murmur with a click that occurs later with squatting.
Squatting increases both preload and afterload, enlarging left ventricular volume. This delays leaflet prolapse in mitral valve prolapse.
A larger left ventricular volume keeps the mitral leaflets tense for a longer period before they prolapse into the left atrium.
3
Evaluate the crescendo-decrescendo murmur that decreases with the Valsalva maneuver.
Decreased preload results in a lower stroke volume across the aortic valve, which softens the murmur of aortic stenosis.
Most forward-flow murmurs decrease in intensity when preload is reduced.
4
Evaluate the holosystolic murmur that increases with sustained handgrip.
Handgrip increases afterload, which raises the backward pressure gradient. This amplifies retrograde flow and murmur intensity in mitral regurgitation.
Higher systemic vascular resistance forces more blood back through the incompetent mitral valve.

Anahtar Kavram

Hemodynamic effects of dynamic auscultation maneuvers on structural heart murmurs
Tahmini Süre:1m 30s
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Cardiovascular System

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