Healthy athlete with Valsalva accentuated murmur! - USMLE Forums
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  #1  
Old 07-05-2011
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Stethoscope Healthy athlete with Valsalva accentuated murmur!

On a football match a 22 yr old boy complains of palpitation. Which relieved on rest. He denied any dizziness, or chest pain. On examination he appears to be healthy and no sob. On auscultation systolic murmur is heard which increase on valsalva. What is the diagnosis?
A. AR
B. MVP
C. HOCM
D. MR
E. VSD
F. ASD
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  #2  
Old 07-05-2011
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This is the hallmark of HOCM
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Old 07-05-2011
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take care both MVP and HOCM increase with valsalva and cause systolic murmur ??

but in this question i would go with HOCM
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Old 07-05-2011
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Dear Kemoo
Actually the increase in intensity is a hallmark of HOCM. What is increased in MVP is in fact the duration of murmur. All other murmurs decrease in intensity with valsalva
Analysis of changes in the intensity and character of the murmur during phase 2 of the Valsalva maneuver is most useful and practical for the differential diagnosis.
  • The intensity of flow murmurs, murmurs of aortic and pulmonary stenosis, tricuspid and mitral regurgitation, aortic and pulmonary regurgitation, and mitral and tricuspid stenosis decreases. The volume of the carotid pulse also decreases.
  • The murmur of hypertrophic cardiomyopathy increases in intensity as the left ventricular outflow size decreases with a decreased venous return. The carotid pulse volume also declines.
  • In mitral valve prolapse there is an early onset of the click and murmur due to the decrease in left ventricular volume. The opposite effects are observed during phase 4
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The above post was thanked by:
mzee74 (07-05-2011), Taiwan_Guy (07-24-2011)
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Old 07-05-2011
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Default murmur diagnosis

It's likely a HOCM. On the other hand it could be a mitral valve prolapse. Hocm is in keeping with the age.
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  #6  
Old 07-05-2011
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Answer is hocm. MVP is not a option. In exam i dont think they give two choices for similar thing. But if given what we have to select ...so i just added MVP as a option here to see what u guys have to say. In actual one mvp not mentioned
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Cardiology-, Clinical-Signs, Internal-Medicine-, Step-2-Questions

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