Handgrip maneuver
The handgrip maneuver is performed by clenching one's fist forcefully for a sustained time until fatigued. Variations include squeezing an item such as a rolled up washcloth.
Physiological Response
The handgrip maneuver increases afterload by squeezing the arterioles and increasing total peripheral resistance.[1]
Cardiology
Since increasing after load will prevent blood from flowing in a normal forward path, it will increase any murmurs that are due to backwards flowing blood.[2] This includes aortic regurgitation (AR), mitral regurgitation (MR), and a ventricular septal defect (VSD).
Mitral valve prolapse: The click and the murmur of mitral valve prolapse are delayed because of the increased left ventricular volume.[3]
Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity.
Mitral stenosis: The diastolic murmur of mitral stenosis decreases because it is a forward-flow murmur.[2][4]
The effect of reducing the intensity in forward flowing murmurs is much more evident in aortic stenosis rather than mitral stenosis. The reason for this is that there is a larger pressure gradient across the aortic valve.[5] A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.
Handgripping maneuver | Cardiac Finding |
---|---|
Increased murmur intensity | Aortic regurgitation |
Mitral regurgitation | |
Ventricular septal defect | |
Decreased murmur intensity | Aortic stenosis |
Hypertrophic cardiomyopathy | |
See also
References
- ↑ Chirinos, Julio A; Segers, Patrick; Raina, Amresh; Saif, Hassam; Swillens, Abigail; Gupta, Amit K; Townsend, Raymond; Emmi, Anthony G; Kirkpatrick, James N; Keane, Martin G; Ferrari, Victor A; Wiegers, Susan E; St. John Sutton, Martin G (2010). "Arterial pulsatile hemodynamic load induced by isometric exercise strongly predicts left ventricular mass in hypertension". American Journal of Physiology. Heart and Circulatory Physiology. 298 (2): H320–H330. doi:10.1152/ajpheart.00334.2009. PMID 19966060.
- 1 2 McCraw, D B; Siegel, W; Stonecipher, H K; Nutter, D O; Schlant, R C; Hurst, J W (1972). "Response of heart murmur intensity to isometric (handgrip) exercise". Heart. 34 (6): 605–10. doi:10.1136/hrt.34.6.605. PMC 458507. PMID 5064766.
- ↑ Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
- ↑ Kanu Chatterjee (May 9, 1999). "Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds". Archived from the original on June 15, 2012.
- ↑ http://www.merckmanuals.com/professional/sec07/ch076/ch076c.html%5Bfull+citation+needed%5D