Which murmur intensity change happens with maneuvers in mitral regurgitation?

In mitral regurgitation, the murmur intensity is influenced by changes in systemic vascular resistance and preload. The handgrip maneuver increases systemic vascular resistance, which leads to increased left atrial pressure. This, in turn, enhances the volume of regurgitant flow across the incompetently closing mitral valve during systole. As a result, the murmur associated with mitral regurgitation becomes louder or more prominent.

Understanding the physiology behind these changes is crucial. When performing the handgrip maneuver, there is an increase in afterload and, subsequently, a rise in left ventricular pressure, which exacerbates the backward flow across the mitral valve during systole. Therefore, the correct response indicates that the murmur's intensity increases with the handgrip maneuver, making it a notable feature for clinicians evaluating mitral regurgitation.

Other maneuvers like Valsalva actually decrease venous return and preload, which would typically reduce the murmur intensity in cases of mitral regurgitation. Squatting increases venous return, which can also increase the murmur, but not in the same direct manner as the handgrip might. Inspiration generally increases the venous return due to the decrease in intrathor