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.
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. This includes aortic regurgitation (AR), mitral regurgitation (MR), and a ventricular septal defect (VSD).
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. A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.
|Handgripping maneuver||Cardiac Finding|
|Increased murmur intensity||Aortic regurgitation|
|Ventricular septal defect|
|Decreased murmur intensity||Aortic stenosis|
- 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.
- 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.
- Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
- 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.
- http://www.merckmanuals.com/professional/sec07/ch076/ch076c.html[full citation needed]