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[1] by squeezing the arterioles and increasing total peripheral resistance.[2]

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.[3] This includes aortic regurgitation (AR), mitral regurgitation (MR), and a ventricular septal defect (VSD).[4]

Mitral valve prolapse: The click and the murmur of mitral valve prolapse are delayed because left atrial volume also increases due to mitral regurgitation along with increased left ventricular volume.[5]

Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity.[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.[6] A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.[7]

Handgripping maneuverCardiac Finding
Increased murmur intensity Aortic regurgitation
Mitral regurgitation
Ventricular septal defect
Decreased murmur intensity Aortic stenosis
Hypertrophic cardiomyopathy

See also

References

  1. ↑ Thomas, Seth L.; Heaton, Joseph; Makaryus, Amgad N. (2023), "Physiology, Cardiovascular Murmurs", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30247833, retrieved October 26, 2023
  2. ↑ 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. S2CID 1191870.
  3. ↑ 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.
  4. 1 2 "Aortic Regurgitation". The Lecturio Medical Concept Library. October 2020. Retrieved June 29, 2021.
  5. ↑ Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
  6. ↑ "Aortic Stenosis - Cardiovascular Disorders - Merck Manuals Professional Edition". June 28, 2018. Archived from the original on June 28, 2018. Retrieved August 16, 2021.
  7. ↑ Taylor, D (1996). "The Valsalva Manoeuvre: A critical review". South Pacific Underwater Medicine Society Journal. 26 (1). ISSN 0813-1988. OCLC 16986801. Archived from the original on May 8, 2008. Retrieved June 29, 2021.{{cite journal}}: CS1 maint: unfit URL (link)
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