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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]
Afterload is the mean tension produced by a chamber of the heart in order to contract. It can also be considered as the ‘load’ that the heart must eject blood against. Afterload is, therefore, a consequence of aortic large vessel compliance, wave reflection, and small vessel resistance (LV afterload) or similar pulmonary artery parameters (RV afterload
When both the heart and lungs are healthy, pulmonary wedge pressure is equal to left ventricle diastolic pressure and can be used as a surrogate for preload. [3] Pulmonary wedge pressure will overestimate left ventricle pressure in people with mitral valve stenosis, pulmonary hypertension and other heart and lung conditions. [4]
This is due to the decreased preload in this phase, worsening the obstruction and thus accentuating the murmur. [3] At the same time, the Valsalva maneuver (phase II) decreases the intensity of most other murmurs, including those resulting from aortic stenosis and atrial septal defect. The decrease in murmur intensity occurs from a smaller ...
Under normal circumstances, in the absence of aortic stenosis, the heart is able to increase its output and thereby offset the effect of the dilated blood vessels. In some cases of aortic stenosis, however, due to the obstruction of blood flow out of the heart caused by the stenosed aortic valve, cardiac output cannot be increased. Low blood ...
In individuals with aortic stenosis, after a premature ventricular contraction (PVC), the following ventricular contraction will be more forceful, and the pressure generated in the left ventricle will be higher. Because of the fixed obstruction that the stenotic aortic valve represents, the post-PVC ascending aortic pressure will increase as well.
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