Which of the following murmurs increase with valsalva maneovre
**Core Concept**
The Valsalva maneuver involves forced expiration against a closed glottis, increasing intrathoracic pressure and affecting cardiac output. This leads to a decrease in venous return and subsequently a decrease in left ventricular volume. The murmurs that increase with the Valsalva maneuver are those that are dependent on increased left ventricular volume, such as those due to aortic regurgitation.
**Why the Correct Answer is Right**
During the Valsalva maneuver, the decreased venous return and left ventricular volume reduce the pressure gradient across the aortic valve, increasing the intensity of the murmur of aortic regurgitation. This is because the murmur of aortic regurgitation is caused by the backflow of blood from the aorta into the left ventricle during diastole, and a decrease in left ventricular volume exacerbates this backflow. The increased intensity of the murmur of aortic regurgitation with the Valsalva maneuver is a classic clinical finding.
**Why Each Wrong Option is Incorrect**
**Option A:** The murmur of mitral stenosis actually decreases with the Valsalva maneuver, as decreased left ventricular volume reduces the pressure gradient across the mitral valve and decreases the intensity of the murmur.
**Option B:** The murmur of pulmonary stenosis is not significantly affected by the Valsalva maneuver, as it is not dependent on left ventricular volume.
**Option C:** The murmur of tricuspid regurgitation does not increase with the Valsalva maneuver, as it is not directly affected by the changes in left ventricular volume.
**Clinical Pearl / High-Yield Fact**
The Valsalva maneuver can be used to differentiate between the murmurs of aortic regurgitation and mitral stenosis, as the murmur of aortic regurgitation increases in intensity with the Valsalva maneuver, while the murmur of mitral stenosis decreases.
**Correct Answer:** A.