Handgrip maneuver explained

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

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

Cardiology

Since increasing afterload 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).^[3]

Mitral valve prolapse

The click and the murmur of mitral valve prolapse are delayed because left atrial volume also increases due to mitral regurgitation along with increased left ventricular volume.^[4]

Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity.^[3]

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.^[6]

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

See also

• Valsalva maneuver
• Preload
• Afterload

Notes and References

1. 10.1152/ajpheart.00334.2009 . 19966060 . 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 . 2010 . 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 . 1191870 .
2. 10.1136/hrt.34.6.605 . 5064766 . 458507 . Response of heart murmur intensity to isometric (handgrip) exercise . Heart . 34 . 6 . 605–10 . 1972 . McCraw . D B . Siegel . W . Stonecipher . H K . Nutter . D O . Schlant . R C . Hurst . J W .
3. Web site: Aortic Regurgitation. The Lecturio Medical Concept Library . October 2020. 29 June 2021.
4. Tanser, Paul H. (reviewed Mar 2007). "Mitral Valve Prolapse", The Merck Manuals Online Medical Library, Retrieved 2011-01-08.
5. Web site: 2018-06-28. Aortic Stenosis - Cardiovascular Disorders - Merck Manuals Professional Edition. 2021-08-16. https://web.archive.org/web/20180628015536/https://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/aortic-stenosis. June 28, 2018.
6. Taylor . D . The Valsalva Manoeuvre: A critical review . South Pacific Underwater Medicine Society Journal . 26 . 1 . 1996 . 0813-1988 . 16986801 . https://web.archive.org/web/20080508210947/http://archive.rubicon-foundation.org/6264 . usurped . May 8, 2008 . 29 June 2021.