HEART MURMURS MADE EASY

1. There are four systolic murmurs of concern-MR, VSD, AS, and HOCM. 2. There are five manuevers: Remember this mnemonic--VALSH (Valsalva, AmylNitrate, Leg Raising, Squatting, Handgrip-also called Phenylephrine 3. The next step is to remember the response to maneuvers for HOCM. Remember that out of VALSH, VA-cause increase in the murmur of HOCM. LSH-causes decrease in the murmur of HOCM. 4. Except for V and L all the responses of AS (aortic Stenosis) are the same as HOCM. [That is AS murmur too increases with A and decreases with SH] For V and L the response is opposite. That is The AS murmur decreases with V and increases with L. 5. The response for MR and VSD is totally the opposite that of HOCM except for squatting which does not affect the murmur of MR and VSD. Legend: MR- Mitral Regurgitation VSD-Ventricular Septal Defect HOCM-Hypertrophic Obstructive Cardiomyopathy AS-Aortic Stenosis V-Valsalva Manuever A-Amyl Nitrate L-Leg raising S-Squatting H-Hand Grip, also called Phenylephrine