HCM can be obstructive or non obstructive.
Obstruction occurs at level of LVOT. This produces ESM which is well heard in
lower left parasternal area or at apex. Intensity and duration of murmur
increase with severity of obstruction.
which is due to diastolic dysfunction of heart is produced due to forceful
atrial contraction. S4 can occur in both obstructive and non obstructive HCM.
S3 can also occur due to associated MR.
In patient with ESM with brisk raise of
pulse which goes against valvular AS, one has to consider HOCM. Valvular AS
produces slow raising pulse
Pulse of HOCM is bisferance type i.e.
initial spike is brisk during this initial part (around 80 to 90% of systolic
ejection occurs). This is followed by dip in pulse due occurrence of obstruction
and again on more slow raising peak.
Bisferance pulse is classically
described with severe AR, which is associated with EDM but not HOCM with
Apical impulse of HCM is very important
sign. S4 is palpable, this is followed by early systolic contraction, followed
by one more impulse due to occurrence of obstruction, so patient may have triple
Presence of Loud S4 is a rule in HCM
About 30-50% of HOCM are associated with
mitral regurgitation. HCM with MR produces a systolic murmur, which is much
longer with both ejection and regurgitant quality. Site of maximal intensity is
lower than the site of ejection murmur.
differential feature between HCM and AS is carotid impulse which is slow
raising in valvular AS and brisk in HCM
thrill is present in AS and rare in HCM
of HCM is lower down in precardium where as of valvular AS is on right side
PVC augmentation is more pronounced in HCM than AS
of holosystolic murmur at apex suggest possibility of MR than HCM
which cardinal sign of HCM is unusual in chronic MR, but in acute MR S4 can
is much more common in HCM.
HCM and MR have quick raise of carotid impulse.
splitting is heard in HCM, but in MR wide splitting is heard.
PVC, MR murmur does not change but HCM and AS murmur increases.
and is not heard in MVP
PVC murmur of MVP does not increase
Labels: For Doctors, Heart Failure