List of murmurs and diagnostic maneuvers.

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Rothbard

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Does anyone have a good source for this? For example, the effect of inspiration/expiration/squatting/etc. on tricuspid/mitral/pulmonic/etc. stenosis/regurg/prolapse/etc.

First Aid seems to have a lot of errors here, it's driving me crazy.

This is taken from a prep4Usmle.com forum. Its definitely better to understand it (for the questions where you have to apply the concept) but I would also say having a mnemonic like this memorized makes answering the easier questions alot faster. Good luck!


Here is an easy way to remember everything about cardiac murmur and maneuvers:

1. The are four systolic murmurs of concern: MR, VSD, AS and HOCM.
2. The are five manuevers: Remember this mnemonic:
VA-LSH ( Valsalva, AmylNitrate, Leg raising, Squatting, Handgrip-also called Phenylephrine)
3.The next step is to remember the response to maneuvers for HOCM. Please remember that out of VALSH, VA-cause increase in the murmur of HOCM, -LSH cuase decrease in the murmur of HOCM.
4. Except for V and L all the responses of AS ( aortic stenosis) are the same as HOCM. That is AS murmur too increase with A and decrease with SH. For V and L the response is opposite with HOCM, that is the AS murmur decrease with V and increase with L.
5. The response for MR and VSD is totally the opposite that of HOCM except for squatting which does not affect the murmur of MR and VSD.

Legend:

MR: Mitral Regurgitation
VSD: Ventricular Septal Defect
HOCM: Hypertrophic Obstructive Cardiomyopathy
AS: Aortic Stenosis
V: Valsalva Manuever
A: Armyl Nitrate
L: leg raising
S: Squatting
H: Hand Grip, also called Phenylephrine
 
Thanks Step, but I'm not sure about that mnemonic. I just checked Bates, and it says AS increases with squatting.

Squatting is weird bc its different in short term and in long term. In short term you get an increase in preload (veins constrict and blood pushes up the IVC) but in long term you get an increase in afterload (arterioles get constricted). I think this difference is because veins are low pressure and thus easier to constrict but over time prolonged squatting increases the ability to constrict the higher pressure arterioles. For what its worth, any questions in uworld/nbme/other I would always go with squatting increasing afterload (if It wasn't clear that it was short term) and I don't think I have missed a question. The main scenario I saw questions on it was in TOF (which was on my actual step 1).
 
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