The handgrip maneuever 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.
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The handgrip maneuver increases afterload by squeezing the arterioles and increasing Total Peripheral Resistance. This is similar to the squatting maneuver (which also increases afterload). The main difference is that the hand grip test does not increase venous return.[1]
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 Ventricular Septal Defects (VSD) (murmur increases in intensity).
Murmurs that are due to forward flowing blood such as Aortic Stenosis, Mitral Stenosis, Hypertrophic Cardiomyopathy and Mitral valve prolapse are improved (murmur decreases in intensity)
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.[3] A complementary maneuver for differentiating disorders is the Valsalva maneuver, which decreases preload.
| Effect | Cardiac Finding |
|---|---|
| Increased | |
| Aortic Regurgitation | |
| Mitral Regurgitation | |
| Ventricular Septal Defect | |
| Decreased | |
| Aortic Stenosis | |
| Mitral Stenosis | |
| Hypertrophic Cardiomyopathy |