Question
Maneuvers that decrease the murmur of obstructive HCM include all except
| A. |
Squatting
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| B. |
Sustained handgrip
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| C. |
Nitroglycerin
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| D. |
Passive leg raising
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Show Answer
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Correct Answer � C
Explanation
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|
Ans. C
Interventions that increase myocardial contractility like exercise, sympathomimetic amines & digitalis glycosides, and those that reduce ventricular volume like Valsalva maneuver, sudden standing, nitroglycerin, amyl nitrite or tachycardia, may all cause an increase in the gradient & the murmur. Conversely, elevation of arterial pressure by phenylephrine, squatting, sustained handgrip, augmentation of venous return by passive leg raising & expansion of the blood volume all increase ventricular volume & ameliorate the gradient & murmur
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