Mitral valve prolapse murmur

[Enzymes]

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Mitral valve prolapse murmur

In First Aid 2014, it says that standing/Valsalva decreases the intensity of MVP murmur. This is completely the opposite of what it used to say in the 2013 version (and what most sources say). Is this correct?

 

[crash38]

In my FA 14 (CV phys section), it just says that the murmur will occur earlier with maneuvers that decrease venous return. I interpreted this as meaning that the murmur actually does increase in intensity during the valsalva maneuver (sooner = more severe). As opposed to squatting, which would increase venous return and create more tension on the chordae tendinae keeping the valve shut for longer. (less severe)

 

[targ489]

Less blood in the heart increases the intensity for both hypertrophic and MVP. The MVP will occur sooner with vasalva and standing, with a lot more intensity because the valve has greater laxity to swing up and make a popping noise.

 

[targ489]

Sorry if I just repeated what crash said, didn't read it till afterwards.

 

[ChessMaster3000]

Less blood in the heart increases the intensity for both hypertrophic and MVP. The MVP will occur sooner with vasalva and standing, with a lot more intensity because the valve has greater laxity to swing up and make a popping noise.

So you are basically saying more blood in the LV "weighs down" the chordae preventing them from snapping up (later click)? I always had trouble reasoning why MVP click happened earlier/later.

 

[targ489]

So you are basically saying more blood in the LV "weighs down" the chordae preventing them from snapping up (later click)? I always had trouble reasoning why MVP click happened earlier/later.

Yup exactly. When the valve is loose (less blood in ventricle) more room for snap with more force. When valve is already tightened because there's a ton of blood in the heart, there's not much more room for it to get going to snap, the click occurs later because you pushed it so hard it finally hits towards the end of the contraction.

 

[thehundredthone]

Fortunately for us the mechanics of murmurs don't have yearly editions and errata. Conrad Fisher had a nice way of explaining the click in a video I once saw, he used loose folds of his shirt to explain.

 

[Enzymes]

Hey guys, I wanted to come back this really quickly. My FA 2014 says valsalva and standing decrease murmur intensity for MVP, while Rapid squatting Increases murmur intensity. Is this NOT what everyone else's says? I just never saw this in the errata. So confusing.

 

[evilboy]

Isn't it just a mid-systolic click.

 

[Enzymes]

Isn't it just a mid-systolic click.

Yes, but I am talking about the change in intensity of the murmur.

 

[GadRads]

Hey guys, I wanted to come back this really quickly. My FA 2014 says valsalva and standing decrease murmur intensity for MVP, while Rapid squatting Increases murmur intensity. Is this NOT what everyone else's says? I just never saw this in the errata. So confusing.

Rapid squatting-->increase venous return-->MVP murmur intensity should decrease.

 

[faisal 2000]

the intensity of MVP murmur in standing position and Valsalva will be increased.