Handgrip maneuver

[blazing]

Hey all:

I am finding conflicting information on handgrip maneuver/valsalva on VSD. Step up to medicine says they decrease intensity of VSD. Wiki and SDN forum says it increases. My brain says it increases due to increased afterload, but my guess of SUM's reasoning is that larger the VSD, smaller the murmur, therefore greater afterload is smaller murmur.

Best

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[cbrons]

Hey all:

I am finding conflicting information on handgrip maneuver/valsalva on VSD. Step up to medicine says they decrease intensity of VSD. Wiki and SDN forum says it increases. My brain says it increases due to increased afterload, but my guess of SUM's reasoning is that larger the VSD, smaller the murmur, therefore greater afterload is smaller murmur.

Best

Handgrip increases the harsh holosystolic murmur of VSD