Normalization of the External Carotid Pulse Tracing of Hypertrophic Subaortic Stenosis during Muller's Maneuver

Bartall, Haim; Amber, Saul; Desser, Kenneth B.; Benchimol, Alberto

doi:10.1378/chest.74.1.77

Cited by 7 publications

(2 citation statements)

References 3 publications

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“…[1][2][3][4][5] It has been presumed that this physiologic maneuver increases venous return and therefore, right ventricular flows.' In contradiction to this theory, we have found that the sustained Mueller maneuver decreases cardiac output and stroke volume through the right heart.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography.

et al. 1987

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Ten subjects with normal hemodynamics were studied during elective cardiac catheterization with right and left heart multisensor micromanometry to assess hemodynamic responses to the Mueller maneuver. Simultaneous right and left circulatory hemodynamics and left ventricular, pulmonary arterial, and aortic pressures were recorded, in addition to pulmonary arterial and aortic flow velocities. Steady-state cardiac outputs were determined by thermal dilution. Aortic systolic and mean pressures were not significantly changed during the Mueller maneuver, in contrast to a lower diastolic (p = .019) and higher pulse pressure (p = .016). Mean right atrial pressure (± SE) decreased from 7 1 to -17 + 4 mm Hg (p = .0002) and the right atrial "x" descent was markedly accentuated. Left ventricular end-diastolic pressure decreased from 12 + 4 to -3 ± 13 mm Hg (p = .0025). Systemic vascular resistance and left ventricular peak positive dP/dt were increased during the Mueller maneuver (p < .02), cardiac output and stroke volume were reduced (p < .05), and there was no significant change in heart rate. Right and left peak flow velocities showed a trend toward a bilateral decrease (right, p = .054; left, p > .1), and times to peak flow velocity were increased in the pulmonary artery (p = .007) and reduced in the aortic root (p = .03). Normal subjects were studied separately by pulsed Doppler echocardiography. During the sustained Mueller maneuver, the internal jugular and right ventricular dimensions decreased, and superior vena cava Doppler flow was reduced. These data demonstrate reduced flow through the right and left heart chambers during a sustained Mueller maneuver in humans, in contrast to prior theory and animal data suggesting that right heart flow is increased during sustained forced inspiratory effort.

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Section: Discussionmentioning

confidence: 99%

Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography.

et al. 1987

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“…In the clinical setting, MVO may often be missed in patients. A "spike-and-dome pattern" seen on carotid pulse tracing (CPT) 3 and systolic anterior motion of the mitral valve (SAM) 4 seen on an echocardiogram are known to be specific markers for IHSS. However, no specific markers for MVO have been reported.…”

mentioning

confidence: 99%

Diagnostic Usefulness of Carotid Pulse Tracing in Patients With Hypertrophic Obstructive Cardiomyopathy Due to Midventricular Obstruction

Hamada

Shigematsu

Ohshima

et al. 2003

Chest

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Does This Patient Have an Abnormal Systolic Murmur?

Etchells

Bell²,

Robb³

1997

JAMA

132

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Our objective was to review the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. We conducted a MEDLINE search, manually reviewed all reference lists, and contacted authors of published studies. Each study was independently reviewed by 2 observers and graded for methodologic quality. We found that most studies were conducted using cardiologist examiners. In the clinical setting, the reliability of detecting systolic murmurs was fair (kappa, 0.30-0.48). The most useful findings for ruling in aortic stenosis are a slow rate of rise of the carotid pulse (positive likelihood ratio, 2.8-130), mid to late peak intensity of the murmur (positive likelihood ratio, 8.0-101), and decreased intensity of the second heart sound (positive likelihood ratio, 3.1-50). The most useful finding for ruling out aortic stenosis is the absence of murmur radiation to the right carotid artery (negative likelihood ratio, 0.05-0.10). Smaller, lower-quality studies indicate that cardiologists can accurately rule in and rule out mitral regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, and echocardiographic mitral valve prolapse. We conclude that the clinical examination by cardiologists is accurate for detecting various causes of abnormal systolic murmurs. Studies of the clinical examination by noncardiologists are needed.

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Normalization of the External Carotid Pulse Tracing of Hypertrophic Subaortic Stenosis during Muller's Maneuver

Cited by 7 publications

References 3 publications

Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography.

Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography.

Diagnostic Usefulness of Carotid Pulse Tracing in Patients With Hypertrophic Obstructive Cardiomyopathy Due to Midventricular Obstruction

Does This Patient Have an Abnormal Systolic Murmur?

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