Hypertrophic CMP in Goljan Pathology

[Fuzuli]

Hi everyone,

I've been going over the Cardiology section of RR Pathology and on p188 it lists the maneuvers that effect the murmur produced by HCM, but it basically separates them into those increasing preload and those decreasing preload. However, some of it doesn't make sense. For instance, it puts sustained handgrip in the increasing preload category, but handgripping works by increasing afterload. After spending some time seeking a clarification in other Step I books in futility, I've looked this up in Harrison's and made a list of maneuvers and auscultatory findings. I've attached the file to this post. Hopefully it can be of use for all those studying for the boards.

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[MossPoh]

People way over think this for some reason. When it comes to hypertrophic CMP, you just have to look at what it is doing. It is essentially blocking off the outflow normally. To make the murmur go away, you just do something that gets more blood in there and opens up the works.

 

[unsung]

Hi everyone,

I've been going over the Cardiology section of RR Pathology and on p188 it lists the maneuvers that effect the murmur produced by HCM, but it basically separates them into those increasing preload and those decreasing preload. However, some of it doesn't make sense. For instance, it puts sustained handgrip in the increasing preload category, but handgripping works by increasing afterload. After spending some time seeking a clarification in other Step I books in futility, I've looked this up in Harrison's and made a list of maneuvers and auscultatory findings. I've attached the file to this post. Hopefully it can be of use for all those studying for the boards.

Thanks, man. I recall having been confused by this exact same thing when we did cardio! Actually I wrote an e-mail to my prof about re: handgrip thing, but the guy basically didn't respond.

Anyhow, if it's a typo, that makes a lot more sense.