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Old 09-05-2012
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Default Belindalimm Daily Questions: Pathology #4

A 24-year-old Caucasian male with a documented harsh systolic murmur on cardiac auscultation dies suddenly. His father and uncle also died suddenly in their thirties. A gross autopsy specimen of his heart is shown widening of interventricular septum. Which of the following would most likely increase the intensity of this patient's murmur?

A. Squatting
B. Sustained handgrip
C. Passive leg raising
D. Sudden standing
E. Phenylephrine infusion

Please explain a little bit of mechanism of murmur intensity.
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Old 09-05-2012
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it's d) sudden standing

the pt. and his family are suffering from HOCM..(by hypertrophy of interventricular septum)

since IV septum enlarges..the murmur will be intensified when decreased venous returns...(if increased venous return---EDV increase---not much of obstruction could be seen by the pressure overload.so, murmur with less intensity seen)

causes for increased intensity in HOCM(also in MVP)------sudden standing.,valsalva, amyl nitrite inhalation----all cause decreased venous return

causes for decreased intensity----squatting,handgrip,supine+ leg elevation...due to increased venous return

Last edited by venky2600; 09-05-2012 at 11:29 AM.
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Old 09-05-2012
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Default Sudden standing

footballer's disease
haha...i mean Hypertrophic cardiomyopathy
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Old 09-05-2012
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Quote:
Originally Posted by belindalimm View Post
A 24-year-old Caucasian male with a documented harsh systolic murmur on cardiac auscultation dies suddenly. His father and uncle also died suddenly in their thirties. A gross autopsy specimen of his heart is shown widening of interventricular septum. Which of the following would most likely increase the intensity of this patient's murmur?

A. Squatting
B. Sustained handgrip
C. Passive leg raising
D. Sudden standing
E. Phenylephrine infusion

Please explain a little bit of mechanism of murmur intensity.
I'ts D, as the pathology is HOCM. Any condition that might increase venous return or increase the afterload would result in increase in EDV which in turn overcome the obstruction cause by hypertrophied ventricular septum and alleviate the murmur.
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Old 09-05-2012
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Default my answer :)

D. Sudden standing- decrease in venous return/preload intensifies the murmur in HOCM
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Old 09-05-2012
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Default Yes, the answer is sudden standing

Thank you all for replying to my post!

I chose the wrong answer when encountered this question, and still felt confused about why less blood return lead to decrease the intensity of heart murmur on this particular case. After reading all of your explanation, I grasped the clear picture of the mechanism, you guys helped a lot!

Thank you all again! Appreciate your time and effort!
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