Handgrip maneuver

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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[edit]

The handgrip maneuver increases afterload by squeezing the arterioles and increasing total peripheral resistance.[1]


Since increasing after load will prevent blood from flowing in a normal forward path, it will increase any murmurs that are due to backwards flowing blood.[2] This includes aortic regurgitation (AR), mitral regurgitation (MR), and a ventricular septal defect (VSD).

Mitral valve prolapse: The click and the murmur of mitral valve prolapse are delayed because of the increased left ventricular volume.[3]

Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity.

Mitral stenosis: The diastolic murmur of mitral stenosis decreases because it is a forward-flow murmur.[2][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.[5] A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.

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

See also[edit]


  1. ^ 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.
  2. ^ a b 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.
  3. ^ Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
  4. ^ Kanu Chatterjee (May 9, 1999). "Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds". Archived from the original on June 15, 2012.
  5. ^ http://www.merckmanuals.com/professional/sec07/ch076/ch076c.html[full citation needed]