Quick question on Mitral Valve Prolapse

[knuckles]

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In First Aid, it says the murmur is enhanced by maneuvers that increase TPR (squatting, handgrip).

I was under the impression that MVP and Hypertrophic cardiomyopathy were the two conditions with murmurs that had decreased intensity of murmur, with increased pressure/blood flow. Would someone please clarify? Thanks a lot.

 

[hartbot]

If TPR is increased, less blood can leave thru aorta, so more has to go back up thru mitral valve making the sound louder

 

[knuckles]

True, but I thought mitral valve prolapse was one of the unique murmurs where more blood = less intensity , sort of like the murmur of hypertrophic cardiomyopathy.

Kinda like how decreased preload moves the murmur closer to S1 and increased preload makes the murmur closer to S2.

 

[killinsound]

the reason decreased preload moves it closer to s1 is because you have decreased pressure in the LA to oppose the ventricular contraction.

with an increased afterload you force the blood back to the LA like hartbot said and you will increase the murmur flow rate and therefore sound.
so in effect, increased afterload and decreased preload have the same physical manifestation of increasing backflow.


however, in hypertrophic cardiomyopathy, increasing the afterload would decrease the outflow between the anterior leaflet of the MV and the IVS, decreasing murmur intensity.

 

[knuckles]

you rock