Squatting is a simple physical maneuver that can be done in bed side.
- Squatting increases systemic venous return.
- Raises aortic after load and SVR
It is ideal to do “Stand -Squat -Stand” sequence to appreciate the attenuation during squatting and augmentation during standing
MVPS-MR is a pre load (LV volume ) dependent phenomenon.The degree of prolapse is inversely proportional to the LV size.
Squatting increases the venous return and after load both tend to increase the LV volume. More blood in the LV , means mitral leaflet floats much closer to the mitral annulus . Hence the force of LV contractility is not only less on the prolapsing leaflet , it reaches late , hence the click is delayed and murmur is short (It may be less intense as well * )
(* Squatting increases aortic after load hence the murmur of MR may get amplified .)