Changing the Click and Murmur with Maneuvers or Drugs

1. What happens to the nonejection click and murmur when blood volume to the LV is decreased, as occurs with standing, inspiration, or a Valsalva strain?

ANS: They both occur earlier and they often become louder. Indeed, they may be heard only on sitting or standing.

2. Why does the prolapsed valve murmur become louder and begin earlier on standing or with any maneuver that makes the heart smaller?

ANS: Angiograms have shown that an increase in prolapse occurs in the upright position. This may occur because the redundant tissue acts like the dome of a parachute, whose diameter is decreased if the edges are held down and pulled toward each other. That is, when the ventricle becomes smaller and the diameter is reduced, the center of the "parachute" is pushed up, owing to the fixed length of chordae and papillary muscles in the smaller ventricle.

3. What maneuver can tell you that a crescendo systolic murmur to the S2 is due to papillary muscle dysfunction rather than to the prolapsed valve syndrome if the latter happens to have no click?

ANS: Only the prolapsed valve murmur will become louder and longer and

Free edge drawn in because valve balloons more here and is held down here

Supine

Standing (heart smaller)

One of the diagnostic characteristics of the ballooned valve murmur is that it becomes louder and begins earlier when the heart is made smaller.

Free edge drawn in because valve balloons more here and is held down here

Supine

Standing (heart smaller)

begin earlier on sitting or standing.

4. How can you differentiate the late systolic murmur of papillary muscle dysfunction from the late systolic murmur of a prolapsed mitral valve (without a click) by auscultation?

ANS: Papillary muscle dysfunction murmurs are usually associated with an S4 and a loud Sj. They often become softer after a sudden long diastole, and increase with squatting or amyl nitrite. Prolapsed valve murmurs have no characteristic Sj, do not usually feature an S4, and may become softer with squatting or amyl nitrite.

Was this article helpful?

0 0
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment