Take this..... -

[ArchivalUser]

Jason

11) A 55-year-old man with recent syncopal episode is admitted to the hospital in congestive heart failure. His blood pressure is 160/100 mm Hg, and pulse is 90/min. He has a grade 2/6 harsh systolic ejection murmur. An echocardiogram reveals a thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following will most likely be found in this patient?
A. Decreased murmur with hand grip
B. Decreased murmur with Valsalva
C. Delayed carotid upstroke
D. Increased murmur with squatting
E. Murmur radiating to carotid arteries

Why?

[ArchivalUser]

peace

is it A- decrease with hand grip? sounds like IHSS.

[ArchivalUser]

Jason R. J

the answer is A because with a hand grip you will increase venous return to the heart which will lead to dec in murmur. Hope i am right

j

[ArchivalUser]

ha

if this is hypertrophic obstructive cardiomyopathy, then B,C, D, and E are wrong. That leaves only A to be a correct answer. Agree???

[ArchivalUser]

usmle

ANSWER: A, HOCM murmur caused by increase in obstruction, which caused by the septum...anything that overcome this obstruction( increase venous return, decrease contrcatility of the hear --ve inotropic agents), will cause the murmur to decrease...in hand grip, you increase the venour return, overcoming the ibstruction)..valsalva causes venous pooling and less venous return...>so more obstruction at the level of the septum...increase the murmur. WHAT DO YOU THINK ?