Beruflich Dokumente
Kultur Dokumente
9781405176255
P2: RNK
BLUK110-Stouffer
August 3, 2007
22:4
APPENDIX 2
Hemodynamic Maneuvers
P1: RNK/...
P2: RNK
9781405176255
BLUK110-Stouffer
August 3, 2007
22:4
294 Appendix
Handgrip sustained for 20 to 30 seconds leads to an increase in systemic vascular resistance, arterial pressure, cardiac output, and left ventricular volume
and filling pressure.
Muellers maneuver is forced inspiration against airway resistance. This
results in decreased intrathoracic pressure and increased LV afterload. In a
study of 10 normal subjects [1], the hemodynamic response to the Mueller
maneuver included:
r no change in aortic systolic and mean pressures
r decreased aortic diastolic pressure
r increased pulse pressure
r large decrease in mean right atrial pressure ( SE) decreased from 7 1 to
17 4 mm
r accentuation of right atrial x descent
r decrease in left ventricular end-diastolic pressure
r increase in systemic vascular resistance
r reduction in cardiac output and stroke volume
r no significant change in heart rate.
In another study of patients with systolic dysfunction, the Mueller maneuver
caused immediate increases in systolic left ventricular transmural pressure and
simultaneous reductions in blood pressure, stroke volume, and cardiac output.
These changes were proportional to the magnitude of the negative intrathoracic
pressure generated [2].
References
1 Condos WR, Latham RD, Hoadley SD, Pasipoularides A. Hemodynamics of the Mueller
maneuver in man: right and left heart micromanometry and Doppler echocardiography.
Circulation 1987;76:1020-1028
2 Hall MJ, Ando S, Floras JS, Bradley TD. Magnitude and time course of hemodynamic
responses to Mueller maneuvers in patients with congestive heart failure. J Appl Physiol
1998;85:14761484.