Need Help with a Cardio Concept

[FutureDoc4]

Okay everyone, my problem is conflicting information (particularly faculty). I need some clarification on HOCM (IHSS).

Where is it best heard? aortic area (upper right sternal border) or as Goljan mentions (pg. 188) left sternal border.

In addition I need to make sure I understand this correctly:

Valsalva and Standing decrease preload, therefore worsens HOCM murmur

Reclining, beta-blockers, squatting and hand clenching (hand grip seems to be an area of contention?--but it makes sense to be that increased SVR would lead to increased preload by impeding emptying) increase preload and would therefore decrease HOCM murmur


I would also like to ask are there any other ejection murmurs you would hear at the lower left sternal border? (besides possibly HOCM?)
Aortic stenosis is opposite of HOCM in these two scenarios. Thanks in advance for clarification.

---

Members don't see this ad.

 

[Sol Rosenberg]

In my class, we weren't given a specific location for the HOCM murmur, but I would think, based upon its pathophysiology, it would be somewhere on the left side in the 5th intercostal space. Probably between the apex and the sternal border, but if Goljan says at the sternal border go with that.

Lower Left sternal border is also where you would best hear the tricuspid murmurs, but they sound nothing like the HOCM murmur (which is kind of an aortic stenosis combined with an S3 -- makes sense, right?)

As far as the HOCM murmur goes, it is mede better (more quiet) by anything which expands LV volume. It looks to me like you have it all straight as you wrote it above.

 

[richse]

In my class, we weren't given a specific location for the HOCM murmur, but I would think, based upon its pathophysiology, it would be somewhere on the left side in the 5th intercostal space. Probably between the apex and the sternal border, but if Goljan says at the sternal border go with that.

Lower Left sternal border is also where you would best hear the tricuspid murmurs, but they sound nothing like the HOCM murmur (which is kind of an aortic stenosis combined with an S3 -- makes sense, right?)

As far as the HOCM murmur goes, it is mede better (more quiet) by anything which expands LV volume. It looks to me like you have it all straight as you wrote it above.

So let me preface this question. I'm a first year and we haven't learned murmurs yet so this may sound stupid but here goes. If you are listening for the Aorta why wouldn't it be heard best in the right 2nd intercostal space?

 

[FutureDoc4]

I did some more digging (thank you for the above responses), Step Up to Medicine does mention the HOCM murmur at the left sternal border. To answer richse, it's because the stenosis is "below" the aortic valve via outflow stenosis from assymetical thickening of the ventricular septum rather than a stenosis at the leaflets (like in aortic stenosis), at least, this is how I am understanding the concept.

 

[Sol Rosenberg]

So let me preface this question. I'm a first year and we haven't learned murmurs yet so this may sound stupid but here goes. If you are listening for the Aorta why wouldn't it be heard best in the right 2nd intercostal space?

We are talking about the murmur associated with hypertrophic outflow cardiomyopathy, which is a hypertrophic ventricular septum that causes an outflow tract obstruction. When I mentioned aortic stenosis in my previous post, I was referring to the sound of the murmur, not the location. To be more clear, I should've said systolic crescendo-decresendo murmur coupled with an S3.