2 March - Cards board review

Posted verbatim - Dr Yarbrough's clarification of murmur maneuvers.  Anyone still confused??

Reminders based on today’s board review:


In general: rIght sided murmurs are louder during Inspiration
lEft sided murmurs are louder during Expiration
a – wave: atrial pressure during atrial contraction
c – wave: increased pressure from tricuspid valve bulge into the RV during isovolumetric ventricular contraction
x –descent: results from downward movement of ventricle during ventricular contraction and atrial relaxation
v – wave: atrial filling
y – descent: decreased pressure from opening of the TV

we usually don’t worry about h and z or a more simplistic view

Standing and Valsalva decrease right and left cardiac filling and lead to decrease murmur intensity except for MVP and HCM

Squatting and Supine position increase ventricular filling and lead to increase murmur intensity except for MVP and HCM

In short: MVP and HCM are increased by standing and valsalva and decreased by squatting and supine position

To differentiate between AS, MVP and HCM use sustained hand grip: this will increase MVP; decrease HCM and AS