A 22-year-old woman with no past medical history is found to have a systolic ejection murmur on routine physical examination. She has no symptoms and feels well. The murmur is heard along the right and left sternal borders and it decreases with handgrip exercises.For the patient with a systolic murmur, select the most likely diagnosis.
The murmur of HOCM often decreases with submaximal isometric exercise (hand-grip). Murmurs across normal or obstructed valves will be increased.Handgrip can also accentuate an S3 or S4.
aortic stenosis
HOCM
mitral regurgitation (chronic)
tricuspid regurgitation
C.V.S.