Hypertrophic Cardiomyopathy: The Daily PANCE Blueprint
What is the characteristic murmur associated with hypertrophic cardiomyopathy?
A. Diastolic murmur best heard at the right upper sternal border
B. Holosystolic murmur that radiates to the carotids
C. Harsh crescendo-decrescendo systolic murmur heard at the apex and left lower sternal border
D. Continuous "machinery" murmur throughout the cardiac cycle
E. None of the above
Answer and topic summary
The answer is C. Harsh crescendo-decrescendo systolic murmur heard at the apex and left lower sternal border
The patient has hypertrophic cardiomyopathy (HCM), which is a genetic disease of the heart muscle due to mutations in the sarcomere genes. It often presents with fatigue, dyspnea, chest pain, palpitations, or syncope. The murmur on the physical exam is due to LV obstruction; it will be a harsh crescendo-decrescendo systolic murmur heard at the apex and left lower sternal border. It’s important to keep in mind that the HCM murmur intensity will DECREASE with increased venous return (i.e., squatting) and INCREASE with less venous return (i.e., Valsalva and lying supine).
Diagnostic tests for HCM include echocardiogram (which will reveal LV hypertrophy), electrocardiogram, and exercise stress testing. Treatment is indicated for symptomatic patients and consists of a negative inotropic agent (i.e., beta blockers, nondihydropyridine calcium channel blockers) and diuretics as needed for volume overload. If patients are refractory to medical therapy, surgical myectomy and percutaneous septal ablation can be performed.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Pediatric Rotation EOR topic list
