Cardiology Murmurs

Hypertrophic Obstructive Cardiomyopathy (HOCM)

The HOCM murmur is louder when the ventricular volume is low, as the outflow tract is narrower, so you can make this murmur louder by having the patient Valsalva or go from squatting to standing. The murmur will become softer by increasing preload, such as with squatting or passive leg raise.
Card Tutorial

Patient 1

This is a middle-aged woman who was admitted to the hospital with a known diagnosis of hypertrophic obstructive cardiomyopathy. Echocardiography demonstrated severe left ventricular outflow tract obstruction with a gradient of 183 mm Hg. It also showed severe mitral valve regurgitation related to systolic anterior motion of the mitral valve. Note that the murmur increases in intensity with Valsalva.

Hypertrophic Obstructive Cardiomyopathy

Annotated