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Auscultatory
findings The most obvious abnormality on physical examination is a heart murmur, which is present in 30 - 40% of patients with HCM. The state of the thickening of the myocardioum can be seen in direct relation to the presence of the murmur. The systolic murmur is harsh and blowing in nature, and cresendo/decresendo in configuration. It is best hear at the apex and the left sternal border. The cresendo/decresendo nature of the murmur is appreciated when listening, however, due to the complexity of frequencies, the phonocardiogram will show a more “rugged” form. The onset of the murmur is shortly after S1, but the space may be difficult to notice. The complexity of the murmur is caused by the fact that usually, both a midsystolic ejection murmur (due to obstuction), and the holosystolic murmur of mitral (and possibly also tricuspid) regurgitation all happens at the same time. An important clue to suspecting HCM based on initial auscultation is to have the patient perform the squatting maneuver. The systolic murmur should become noticeably lower when the patient is squatting, then increasing when standing. Have the patient do this three or four times because the reduced intensity may not occur immediately. Note! It is best for the physician to sit while the patient is doing this maneuver. This prevents unnecessary movement and lack of concentration on behalf of the physician. Other auscultatory findings associated with HCM:
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