Valsalva\Squatting\handgrip: consensus

[hyrule]

I've seen different sources say different things. So far my understanding is Handgrip and Squatting work the same way. They increase both afterload and preload thereby enhancing AS and decreasing intensity of HCM.

Valsalva and standing work the opposite way and decrease preload. They make HCM worse and AS better.

anything missing/incorrect?

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[DuxburyPembroke]

Looks right, except I think handgrip doesn't increase preload..

 

[fahimaz7]

Handgrip increases afterload
Valsalva/standing up decrease preload
Leg raise/squat increases preload.

That's about it.

valsalva/standing up decreases all heart sounds, except HCM and MVP which get louder

 

[kl323]

For Tetralogy of Fallot --> One squats to raise TPR so that there is less of a right to left shunt. So in other words, raising the TPR raised the afterload, correct?

IF that's the case, squatting should cause an increase in afterload, rather than increase proload right?

For the handgrip and valsalva, those make sense to me. Just not the squatting one.

 

[xlr8]

someone on this forum explained to me a better way to understand handgrip.

yes, it does increase afterload, but it's much better to see it as "increasing" the LV volume, as it will explain its effects on HCM and MVP.

 

[pbnj003]

if you increase afterload that means less vl of blood "can" be ejected from the LV....therefore theres more blood left in the ventricle leading to the increase in preload.

 

[mossyfiber12]

so...

standing up - dec proload (makes sense)
valsalva - dec proload due to inc thoracic pressure leading to dec. SVR?
squatting- someone please explain because I just don't get this...

 

[lord_jeebus]

so...

standing up - dec proload (makes sense)
valsalva - dec proload due to inc thoracic pressure leading to dec. SVR?
squatting- someone please explain because I just don't get this...

valsalva -> inc. thoracic pressure -> decreased venous return
squatting -> increased venous return

 

[TeaLover]

Squatting - will increase venous return (thus increased preload) and will increase peripheral vasular resistance (thus increasing afterload)
Hope that helps. =)

 

[mossyfiber12]

okay fair enough. but how does inc afterload (from handgrip) dec aortic stenosis murmur?

inc afterload would lead to dec. EDV in LV. so less Vol = Less pressure (starling's law) thus lower duration of murmur????

 

[Beth1458]

I got this qu in UWORLD and the explanation that they gave was that the ↑ afterload causes a ↓ pressure gradient between the LV and aorta causing a ↓ in murmur intensity.