A 68-year old man who has had a recent syncopal episode is hospitalized with congestive hea failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a dispropoionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man :

**Core Concept**
The patient's clinical presentation and echocardiogram findings are suggestive of Hypertrophic Obstructive Cardiomyopathy (HOCM), a condition characterized by an abnormally thickened ventricular septum and systolic anterior motion of the mitral valve, leading to dynamic left ventricular outflow tract obstruction.

**Why the Correct Answer is Right**
In HOCM, the thickened ventricular septum and abnormal motion of the mitral valve cause a narrowing of the left ventricular outflow tract, resulting in obstruction of blood flow. This obstruction can lead to symptoms such as chest pain, shortness of breath, and syncope. The patient's echocardiogram findings, including a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve, are classic for HOCM. The presence of a harsh systolic murmur, which is typically a crescendo-decrescendo murmur, is also consistent with this diagnosis.

**Why Each Wrong Option is Incorrect**
**Option A:** Left ventricular hypertrophy with a normal ejection fraction is not specific to HOCM and can be seen in other conditions, such as hypertension.

**Option B:** Mitral regurgitation is not a primary feature of HOCM, although it may occur in some cases due to the abnormal motion of the mitral valve.

**Option C:** Aortic stenosis is a different condition characterized by a narrowing of the aortic valve, which can cause a harsh systolic murmur, but it is not consistent with the patient's echocardiogram findings.

**Option D:** This option is not provided.

**Clinical Pearl / High-Yield Fact**
In patients with HOCM, beta-blockers are often used to reduce the heart rate and contractility, which can help alleviate symptoms by reducing the obstruction of the left ventricular outflow tract.

**Correct Answer:** B.

✓ Correct Answer: B. Decrease of the murmur with hand grip