Review Question - QID 100619

This patient has hypertrophic obstructive cardiomyopathy (HOCM) and has developed a murmur due to abnormal systolic anterior motion of the mitral valve.

HOCM is a significant cause of sudden death in young men, especially if it remains undiagnosed. The systolic murmur often associated with this disease is secondary to dynamic outflow obstruction between the hypertrophied left ventricle and the anterior leaflet of the mitral valve. If the obstruction continues to worsen, surgical intervention may be required to relieve the obstruction and improve cardiac function. A systolic murmur due to HOCM increases in intensity when a valsalva maneuver is performed, a systolic murmur due to aortic valve pathology would decrease in intensity.

Figure A shows an EKG with the characteristic findings of HOCM. Note the large voltages in leads V2-V6.

Incorrect Answer:
Answer 1: It would be unusual for a young man to develop calcific aortic stenosis in absence of bicuspid aortic valve.
Answer 2: Mitral stenosis would present with a diastolic heart murmur.
Answer 3: Tricuspid stenosis would present with a diastolic heart murmur and is likely to occur in young IV drug users.
Answer 5: With this family history, HOCM should be suspected until ruled out.