Question

Maneuvers that make the murmur of hypertrophic cardiomyopathy louder:

a) Decreasing preload (Valsalva, standing)
b) Increasing preload (Squatting, leg raising)
c) Increasing afterload (Handgrip, standing)
d) Decreasing afterload (Handgrip, squatting)

Answer 1

Maneuvers that make the murmur of hypertrophic cardiomyopathy louder involve decreasing preload, such as the Valsalva maneuver or standing up, as these reduce ventricular volume and increase the obstruction from hypertrophied heart muscle.

Step-by-step explanation:

Heart murmurs are sounds heard via auscultation that are caused by the turbulent flow of blood. In conditions like hypertrophic cardiomyopathy, which is a pathological enlargement of the heart, these murmurs can be influenced by various maneuvers that alter the hemodynamic load on the heart, such as changes in preload and afterload. The murmur of hypertrophic cardiomyopathy becomes louder with maneuvers that decrease preload, such as the Valsalva maneuver or standing up. These maneuvers reduce the volume of blood in the ventricles before contraction, thus increasing the obstruction caused by hypertrophied myocardium. Conversely, increasing preload like with squatting, or leg raising can make the murmur quieter by increasing the volume of the blood in the ventricles and thereby reducing the outflow tract obstruction.