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Cardiology – Awesome
Maneuvers that determine flow to the heart
| Question | Answer |
|---|---|
| Leg raise | increase venous return to heart |
| sitting | increase venous return to heart |
| squatting | increase venous return to heart |
| valsalva | decrease venous return to heart |
| standing | decrease venous return to heart |
| least amount of blood to the heart is when? | Valsalva on inspiration |
| hand grip | increased afterload |
| after PVC | after the compensatory pause, we have decreased afterload; quick decrease in ventricular volume |
| What happens to HOCM murmur with sitting / leg raise / squatting? | increased volume to heart --> decreased murmur |
| What happens to HOCM murmur with valsalva on inspiration or standing? | decreased volume to heart --> increased murmur |
| What happens to HOCM murmur with hand grip? | decreased |
| What happens to HOCM murmur after PVC? | increased since there is increased obstruction as ventricular volume decreases |
| What happens to MVP murmur with sitting / leg raise / squatting? | increased volume to heart --> valve flops later --> decreased duration of murmur |
| What happens to MVP murmur with valsalva on inspiration or standing? | decreased volume to heart --> valve flops earlier --> increased duration of murmur |
| mid systolic click, late systolic murmur | MVP |
| What happens to MVP murmur with hand grip? | increased after load --> more volume in heart --> later flop (decreased murmur duration), but increased intensity of murmur once flow gets out |
| What happens to MVP murmur after PVC? | decreased after load --> volume in heart decreases fast --> earlier flop (increased murmur duration), but decreased intensity of murmur once flow gets out |
| what valvular defect is associated with cardiac conduction defects | aortic stenosis |
| What happens to aortic stenosis murmur with sitting / leg raise / squatting? | increased venous return --> increased murmur |
| What happens to aortic stenosis murmur with valsalva on inspiration or standing? | decreased venous return --> decreased murmur |
| What happens to aortic stenosis murmur with hand grip? | increased after load --> decreased flow through the valve --> decreased murmur |
| What happens to aortic stenosis murmur after PVC? | decreased after load --> increased flow through the valve --> increased murmur |
| least flow to the R heart | valsalva on expiration |
| least flow to the L heart | valsalva on inspiration |
| what happens to murmurs on inspiration? | increased flow to the R heart -- R-sided murmurs increase |
| what happens to murmurs on expiration? | increased flow to the L heart - L sided murmurs increase (except for HOCM and MVP) |
| what happens to flow to the heart with phenylephrine | increased after load |
| what happens to flow to the heart with amyl nitrite | decreased after load |
| which murmurs increase with standing/valsalva? | MVP and HOCM |
| which murmurs increase with squatting/sitting? | all murmurs except MVP and HOCM |
| which murmurs increase with hand grip? | increased after load --> all murmurs including MR, MVP decreased duration increased intensity |
| which murmurs decrease post PVC? | decreased after load --> MVP increased duration but decreased intensity |
| which murmurs decrease with hand grip? | increased after load so murmurs that decrease are: HOCM more volume in the ventricle, AS decreased flow through the valve, MVP valve flops later --> decreased murmur duration but increased intensity |
| which murmurs increase post PVC? | decreased after load - AS because increased flow through the Ao valve, MVP increased duration but decreased intensity, HOCM increases |