PANCE Blueprint Cardiology (13%)

Cardiac Murmurs with Joe Gilboy PA-C

Cardiac Murmurs Made Simple

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  Venous Return/Preload Afterload Drugs
Increase Decrease Increase Decrease Diuretics ACEIs
  (Leg raise/Squat) (Valsalva/Standing) (Handgrip) (Amyl Nitrate)
MS, AS ↓ (AS) ↑ (AS) MS Better
AS (replace)
x
Negligible Effect in (MS) MS (Balloon)  
MR, AR
VSD
HOCM x x
MVP x x
  • Valsalva → ↑ Intrathoracic pressure → ↓ Blood return to the heart
  • Standing up → ↓ Venous return → ↓ Peripheral vascular resistance ↓ Blood return to the heart
  • Squatting → Squeezes blood up into the heart → ↑Blood return to the heart
  • Handgrip → Contract arms muscle → Compresses arteries of the arm → increases afterload → prevents blood from leaving the ventricles

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