Handgrip maneuver

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]

• Valsalva maneuver
• Preload
• Afterload