Hypertrophic Obstructive Cardiomyopathy: Heart Murmur

 • Occurs during systole 

 • Crescendo-decrescendo murmur

 • Heard best left lower sternal border 

 • Radiates aortic/mitral areas 

 • Increase intensity; reductions in afterload and venous return (standinq, Valsalva manoeuvre, dehydration) 

 • Decrease intensity: elevations in afterload and venous return (squatting, leg elevation, handgrip) 



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