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HCOM!

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tongsaa
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07/16/07 - 04:58 PM

Which of the following finding is found in patient with HCOM?
a.) Decrease in intensity of murmur on Vasalva
b.) Decrease in intensity of murmur on hand grip
c.) Decrease in intensity of murmur following standing after squatting
d.) Increase in murmur following phenylephrine injection
e.) Increase in murmur following leg elevation.

cirus
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07/16/07 - 05:13 PM

b ---> increases afterload

young_doc
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07/16/07 - 05:15 PM

I'm gonna say D. By agonizing alpha-1 receptors with Phenylephrine, we increase the resistance in capillaries and hence decrease Venous Return...thereby worsening HOCM murmur.

Valsalva increases.

Standing increases.

Leg elevation decreases.

Hand-grip i'm not too sure.... confused

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young_doc
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07/16/07 - 05:18 PM

cirus wrote:
b ---> increases afterload

I was thinking that at first, but i remember reading that HOCM murmur is related to ventricular-filling... so i'm not sure how afterload comes into play here confused

But that's just my guess.

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sprint123
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07/16/07 - 05:22 PM

I think it is b---Since increased afterload prevents complete ventricular emtying --->Thereby increasing the volume of blood in the ventricle--->Decreased murmur!

cirus
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07/16/07 - 05:57 PM

young_doc wrote:
I'm gonna say D. By agonizing alpha-1 receptors with Phenylephrine, we increase the resistance in capillaries and hence decrease Venous Return...thereby worsening HOCM murmur.

Valsalva increases.

Standing increases.

Leg elevation decreases.

Hand-grip i'm not too sure.... confused

Phenylephrine is a VC so it increases after load so decreases murmur, hand grip has the same mechanism

young_doc
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07/16/07 - 06:01 PM

True, but the difference is that iv Phenylephrine will cause a systemic increase in TPR... so it will ALSO decrease venous return. (hand-grip will not decrease venous return)

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dr in trouble
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07/16/07 - 07:58 PM

b

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GOGETA
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07/16/07 - 08:03 PM

HCOM?

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khorshid
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07/19/07 - 12:51 PM

#10

B, HCOM's (IHSS) murmur increased by valsalva and amyl nitrate, decreased by squatting and hand grip and leg raising, and phenylephrine

Edited by khorshid on 07/19/07 - 01:03 PM

tongsaa
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07/19/07 - 04:28 PM

#11

B is the ans...

ssrpk
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07/19/07 - 07:57 PM

#12

hey young doc, you are studying really hard, go and take a break friend grin

venous return has not much to do with TPR than it has to do with venous capacitance or venous tone which is not affected by phenylephrine.... do people with hypertension get all wobbly upon standing up????

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