Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 28-year-old male is seen in the clinic for a routine physical examination. He has no complaints and is asymptomatic with no episodes of syncope, and he has no family history of cardiac disease. A II/VI systolic murmur is heard best at the right lower sternal border. The murmur is accentuated with inspiration and decreases with Valsalva. The murmur most likely is due to which of the following?
A. Aortic regurgitation
B. Tricuspid regurgitation
C. Mitral regurgitation
D. Hypertrophic cardiomyopathy
E. Flow murmur
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
The answer is B. I posted this one just to remind everyone some maneuvers
Differentiating between the etiologies of systolic murmurs can be challenging, and in this situation using maneuvers to change cardiac physiology can be quite helpful.
Inspiration increases flow through the right side of the heart and subsequently increases the sound of tricuspid regurgitation.
The Valsalva maneuver will decrease the sound of most murmurs by decreasing preload; the primary exceptions are hypertrophic cardiomyopathy and the late systolic murmur of mitral valve prolapse, which paradoxically are augmented by this maneuver.
Standing, which decreases preload, behaves similarly in response to the Valsalva maneuver.
Squatting, however, increases both venous return and systemic afterload, which will increase the intensity of most murmurs except hypertrophic cardiomyopathy and mitral valve prolapse.
Finally, sustained handgrip increases afterload and heart rate with subsequent accentuation of mitral regurgitation, aortic regurgitation, and mitral stenosis but decreased intensity of the murmur of hypertrophic cardiomyopathy.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Thank you very much for this nice summary!
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
thanks a lot saonew for detailed explanation
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
thanx a lot for ur good review
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
URW, IT IS NICE THAT YOU LIKE THE DETAILS MORE THAN THE QS, I DO BECAUSE I WAS ALSO CONFUSED WHICH ONE DOES WHAT AND NOW ALL TOGETHERE IT IS CLEAR.
