Hypertrophic Cardiomyopathy and Handgrip

[xlr8]

I've seen many places say that the handgrip reduces the murmur intensity, but I don't quite fully understand it.

To me, handgrip is more of an afterload modifier. So I see it as a larger pressure gradient between the LV and the Aorta, giving a louder murmur sound. I understand that the murmur decreases with increasing preload, but an increased preload to me is more like a leg raising/inspiration/venous type thing.

Can someone tell me where I'm wrong in my logic or have a good explanation for this?

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[RySerr21]

I've seen many places say that the handgrip reduces the murmur intensity, but I don't quite fully understand it.

To me, handgrip is more of an afterload modifier. So I see it as a larger pressure gradient between the LV and the Aorta, giving a louder murmur sound. I understand that the murmur decreases with increasing preload, but an increased preload to me is more like a leg raising/inspiration/venous type thing.

Can someone tell me where I'm wrong in my logic or have a good explanation for this?

the reason there is a murmur is b/c the interventricular septum hypertrophies out of proportion to the rest of the heart, so it kinda bulges into the left ventricle. When the mitral valve closes, it ends up hitting the IV septum.

With handgrip, or an increase in afterload, you are making it harder for the blood to leave the heart, or the way I think of it, is that more blood ends up in the LV because it is harder to leave (aka increaes the preload). If theres more blood in the LV, then its going to expand and pushes the IV septum away from the mitral valve, hence the murmur decreases. does that make sense?

 

[xlr8]

the reason there is a murmur is b/c the interventricular septum hypertrophies out of proportion to the rest of the heart, so it kinda bulges into the left ventricle. When the mitral valve closes, it ends up hitting the IV septum.

With handgrip, or an increase in afterload, you are making it harder for the blood to leave the heart, or the way I think of it, is that more blood ends up in the LV because it is harder to leave (aka increaes the preload). If theres more blood in the LV, then its going to expand and pushes the IV septum away from the mitral valve, hence the murmur decreases. does that make sense?

Yes, this is a great explanation! Thank you.

 

[deleted387928]

Does anyone know why increased TPR enhancees Mitral valve prolapse murmur & mid-systolic click?

 

[pbnj003]

Does anyone know why increased TPR enhancees Mitral valve prolapse murmur & mid-systolic click?

if you are reading that from FA 2011....thats an error. increased TPR does not enhance the MVP mumur....it reduces.

Increased TPR would cause an increase in preload in the LV which would facilitate proper closure of the MV therefore reducing the murmur. At least thats how i understand it. I think it brings it closer to S1.

Hope this helps and not confuse you more. Murmurs are my weakness, one minute I understand them next minute I forget em. God help me lol