Which maneuver can be used to reduce venous return and augments the prolapse?

• A. Valsalva Maneuver
• B. Handgrip Maneuver
• C. Squatting
• D. Deep Inspiration

Answer: (A)

Prolapse is highly preload dependent: when venous return to the heart is reduced, the left ventricle ends up with a smaller volume in systole, so the mitral leaflets have less support and can billow further into the left atrium. The Valsalva maneuver raises intrathoracic pressure during the strain phase, which compresses the venous system and markedly reduces venous return. That drop in LV volume intensifies the systolic prolapse of the mitral valve and often sharpens the associated murmur.

Other maneuvers either increase preload (like squatting or deep inspiration, which bring more blood into the heart) or primarily affect afterload (handgrip) without producing the same reduction in venous return, so they don’t accentuate prolapse to the same extent.