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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