Which of the following murmur increases on standing
Correct Answer: hyperophic obstructive cardiomyopathy
Description: * HOCM is associated with a midsystolic murmur(loudest along the left sternal border / between the left lower sternal border and the apex. * The murmur is produced in both MR and dynamic left ventricular outflow obstruction. Therefore its configuration is a hybrid between regurgitant and ejection phenomena. The murmur intensity varies from beat to beat and after provocation maneuvers and does not exceed grade 3. The murmur increases in intensity following maneuvers that increase the degrees of outflow tract obstruction like reduction in preload or afterload (vasodilators, standing, valsalva). The intensity of murmur is decreased by maneuvers that increase preload (volume administration, passive leg raising, squatting) or afterload (vasopressors, squatting) or that reduce contractility (beta blockers). Ref:- Harrison'sTM Principles of Internal Medicine 20th edition; Pg num:- 243
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