Hand-grip tends to decrease the intensity of which murmur?

• A. Aortic regurgitation
• B. Aortic stenosis
• C. Mitral regurgitation
• D. Tricuspid regurgitation

Answer: (B)

Hand-grip increases afterload by raising systemic vascular resistance. Murmurs respond differently to this change depending on whether they are driven by a pressure gradient during systole or by regurgitant flow. For aortic stenosis, the murmur comes from high-velocity flow across a narrowed valve during systole. When afterload is higher, the left ventricle can’t achieve the same systolic pressure relative to the aorta, so the gradient across the aortic valve decreases and the murmur becomes softer. That’s why hand-grip tends to decrease the intensity of the aortic stenosis murmur.

Murmurs due to regurgitation (such as mitral or tricuspid) often become louder with hand-grip because the increased afterload amplifies the regurgitant flow during systole. Aortic regurgitation can be variable, but the classic teaching is that the AS murmur specifically diminishes with this maneuver.