How can you tell the difference between aortic stenosis and HOCM?

How can you tell the difference between aortic stenosis and HOCM?

Physical Examination – HOCM The murmur of HOCM does not radiate to the carotids like that of aortic stenosis. The important auscultatory features of HOCM that distinguish it from AS relate to dynamic auscultation. The murmur of HOCM becomes quite loud with Valsalva maneuver.

Why are there two murmurs in HOCM?

Two murmurs are often cited as being present in patients with HCM. The first murmur is because of systolic anterior motion (SAM) of the mitral valve leading to poor leaflet coaptation and mitral regurgitation (Fig. 2B and C).

What is the difference between HCM and HOCM?

This type of hypertrophic cardiomyopathy may be called hypertrophic obstructive cardiomyopathy (HOCM). HCM also may cause thickening in other parts of your heart muscle, such as the bottom of your heart (called the apex), right ventricle or throughout your entire left ventricle.

What increases murmur of HOCM?

The murmur and the gradient across the LVOT will decrease with an increase in preload (Squatting) or an increase in afterload (handgrip). In addition, the gradient and the murmur will increase with a decrease in preload (Valsalva maneuver, diuretics, standing). Certain maneuvers can affect murmurs auscultated in HOCM.

How can you tell the difference between HOCM and MVP?

An MVP murmur can be distinguished from a hypertrophic cardiomyopathy murmur by the presence of a mid-systolic click which is virtually diagnostic of MVP. The handgrip maneuver diminishes the murmur of an MVP and the murmur of hypertrophic cardiomyopathy.

Why does HOCM murmur increases with Valsalva?

The murmur of HOCM becomes quite loud with Valsalva. By decreasing left ventricular filling, the left ventricular outflow tract obstruction worsens, making the murmur louder.

Why are ACE inhibitors contraindicated in HOCM?

Agents to reduce pre- or afterload (such as nitrate, ACE inhibitors, nifedipine-type calcium antagonists) are contraindicated with HOCM due to possible aggravation of the outflow tract obstruction. This often impedes therapy of coexistent arterial hypertension.

Are there different types of HCM?

There are two types of HCM: a more common, obstructive type (HOCM, 70%) in which there is left ventricular outflow obstruction and a less common, non-obstructive type (HNCM).

Where is HOCM murmur heard?

The murmur of HOCM is a medium-pitched ejection murmur best heard at the left sternal border.

Why does HOCM murmur increase with Valsalva?

Why does HCM murmur decrease with handgrip?

Hand grip will increase left ventricular afterload and decrease left ventricular emptying, thus inducing a relative increase in left ventricular volume during systole. The effect on the murmur of HOCM is that of diminished intensity (10).