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 afterload 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 increases because of an increased heart rate, blood pressure and cardiac output [4][5]
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.[6] 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 | |
| Mitral Valve Prolapse |
See also
References
- ↑ http://ajpheart.physiology.org/content/298/2/H320.full
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
- ↑ http://heart.bmj.com/content/34/6/605.full.pdf
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ http://www.merckmanuals.com/professional/sec07/ch076/ch076c.html
