Hand grip- intensity of murmurs

[thecalccobra]

I can't quite conceptualize how performing handgrip (which increases afterload) would increase the intensity of MR, VSD, and AR. Anyone care to explain?

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[MrBeauregard]

Sustained handgrip maneuver:
By performing the sustained handgrip maneuver, total peripheral resistance is increased. This results in an increased afterload. Stated another way, the left ventricle must contract against an increased pressure in the aorta in order to eject blood.

Mitral regurgitation:
In this scenario, taking into account the aforementioned physiological changes, the tendency is for blood to flow in a retrograde fashion. Thus, instead of blood flowing into the aorta, it encounters the increased afterload and flows retrograde from the left ventricle, through the mitral valve, and into the left atrium. This increases the murmur of mitral regurgitation.

Ventricular septal defect:
This scenario is very similar to that of MR except that the blood flows through the VSD and not the mitral valve, accentuating the murmur of VSD.

Aortic regurgitation:
In this scenario, the afterload is transmitted to the incompetent aortic valve resulting in retrograde flow through the aortic valve into the left ventricle. The result: accentuation of the murmur of aortic regurgitation.

 

[thecalccobra]

Thanks a lot!