g*******g
发帖数: 196 | 1 2014 FA P272
valsalva, MVP murmur decrease
squatting, MVP murmur increase
UW Q BANK Q944
写得和FA相反
参考google，我觉得UW是对的
hand grip,FA 写得是MVP murmur increase，但我觉得应该是减弱，因为afterload
increase
请大家帮忙一起讨论一下，谢谢 | n***a
发帖数: 1373 | 2 Valsalva, MVP murmur increases. Less blood in the heart makes the prolapse
more obvious.
【在 g*******g 的大作中提到】
: 2014 FA P272
: valsalva, MVP murmur decrease
: squatting, MVP murmur increase
: UW Q BANK Q944
: 写得和FA相反
: 参考google，我觉得UW是对的
: hand grip,FA 写得是MVP murmur increase，但我觉得应该是减弱，因为afterload
: increase
: 请大家帮忙一起讨论一下，谢谢
| g*******g
发帖数: 196 | 3 Thanks！！
how about hand grip？
FA 写得是MVP murmur increase，但我觉得应该是减弱，因为afterload increase
prolapse
【在 n***a 的大作中提到】
: Valsalva, MVP murmur increases. Less blood in the heart makes the prolapse
: more obvious.
| t******a
发帖数: 408 | 4 From CK study,
The murmur of MVP [and HOCM] gets worse when the heart chamber LV size
becomes smaller.
Thus, Valsava, standing ---> decr chamber size ---> worse murmur
squatting, handgrip ---> incr LV chamber size ---> murmur improved
【在 g*******g 的大作中提到】
: 2014 FA P272
: valsalva, MVP murmur decrease
: squatting, MVP murmur increase
: UW Q BANK Q944
: 写得和FA相反
: 参考google，我觉得UW是对的
: hand grip,FA 写得是MVP murmur increase，但我觉得应该是减弱，因为afterload
: increase
: 请大家帮忙一起讨论一下，谢谢
| g*******g
发帖数: 196 | 5 谢谢！！！
【在 t******a 的大作中提到】
: From CK study,
: The murmur of MVP [and HOCM] gets worse when the heart chamber LV size
: becomes smaller.
: Thus, Valsava, standing ---> decr chamber size ---> worse murmur
: squatting, handgrip ---> incr LV chamber size ---> murmur improved
| n***j
发帖数: 184 | 6 For murmurs, the volume of the murmur is related to the flow thru the valve.
e.g the higher the flow thru the valve, the higher volume the murmurs will
be.
The rule above applies to every clinical scenario except HCM and MVP.
In HCM, less flow, less preload to LV, more obstruction, louder murmur.
In MVP, less flow, less preload to LV, less tenser the chordae tendineae,
more space for prolapse, louder murmur
Generally speaking, increasing afterload decreases flow. Increasing preload
increases flow.
Hope this is helpful. | R****Z
发帖数: 32 | 7 本来觉得没什么疑问，现在脑子反而像一团浆糊，疑问在于：
1.MVP的murmur机理是MV过长松弛，LV收缩时，MV飘向LA，腱索突然被拉紧的声音（单
纯MVP，不伴有MR的时候），那LV less preload，murmur early onset,and longer
duration，但是冲击瓣膜的pressure减少，intensity到底是louder还是lower？
2.valsava动作strain跟release期对于MVP murmur是完全相反吗？
不管了，考试估计只会让听个声音吧 | n***j
发帖数: 184 | 8 Re: MVP, less preload, less tense the chordae tendieae (CT), longer distance
the mitral valve needs to travel from the relaxed position to closed
position. So louder murmur. You may take a look at the anatomy from google
image and see the position of the mitral valve.
Valsava is all about increasing intraabdominal pressure so we usually pay
attention to the change during the strain part. But you are right, strain
and release have opposite effects on the murmur. | R****Z
发帖数: 32 | 9 真爽，干净利落,大赞！谢过！
distance
【在 n***j 的大作中提到】
: Re: MVP, less preload, less tense the chordae tendieae (CT), longer distance
: the mitral valve needs to travel from the relaxed position to closed
: position. So louder murmur. You may take a look at the anatomy from google
: image and see the position of the mitral valve.
: Valsava is all about increasing intraabdominal pressure so we usually pay
: attention to the change during the strain part. But you are right, strain
: and release have opposite effects on the murmur.
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