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 & Mitral valve prolapse
Ventricular septal defect
Decreased murmur intensity Aortic stenosis
Hypertrophic cardiomyopathy

See also

References

  1. ↑ http://ajpheart.physiology.org/content/298/2/H320.full
  2. ↑ "Response of heart murmur intensity to isometric (handgrip) exercise". Br Heart J. 34 (6): 605–10. June 1972. doi:10.1136/hrt.34.6.605. PMC 458507Freely accessible. PMID 5064766.
  3. ↑ Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
  4. ↑ http://heart.bmj.com/content/34/6/605.full.pdf
  5. ↑ Kanu Chatterjee (May 9, 1999). "Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds".
  6. ↑ http://www.merckmanuals.com/professional/sec07/ch076/ch076c.html
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