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.[citation needed]
The handgrip maneuver increases afterload[1] by squeezing the arterioles and increasing total peripheral resistance.[2]
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.[3] This includes aortic regurgitation (AR), mitral regurgitation (MR), and a ventricular septal defect (VSD).[4]
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.[5]
Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity.[4]
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.[6] A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.[7]
| Handgripping maneuver | Cardiac Finding |
|---|---|
| Increased murmur intensity | Aortic regurgitation |
| Mitral regurgitation | |
| Ventricular septal defect | |
| Decreased murmur intensity | Aortic stenosis |
| Hypertrophic cardiomyopathy |
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