A 16 year old male is referred by high school coach for a physical examination before joining the football team. His elder brother had died suddenly during football practise, no autopsy was done. The patient has a loud systolic murmur on chest auscultation. All of the following would be constant with hyperophic cardiomyopathy, except :
Answer is D (Pathophysiological Systolic Dysfunction) The ubiquitous pathophysiological abnormality in Hyperophic Obstructive Cardiomyopathy (HOCM) is not systolic but rather diastolic dysfunction. Hyperophic Obstructive Cardiomyopathy (HOCM) characterized by Asymmetrical Septa! Hyperophy and Dynamic Left Ventricular Outflow Obstruction. Dynamic LV outflow obstruction is related to narrowing of the subaoic area as a consequence of opposition of anterior mitral valve leaflet against the hyperophied septum in mid-systole. The concept is termed Systolic Anterior Motion (SAM) of the mitral valve. The ubiquitous pathophysiological abnormality in Hyperophic Obstructive Cardiomyopathy (HOCM) is not systolic but rather diastolic dysfunction
A crescendo-decrescendo systolic murmur
Murmur radiating to neck
Brisk carotid upstroke
Increase in murmur during valsalva or standing