A 40-year-old man presents to the Emergency Department after fainting while exercising. He reports past episodes of chest pain that do not radiate. The intensity of an IV systolic... A 40-year-old man presents to the Emergency Department after fainting while exercising. He reports past episodes of chest pain that do not radiate. The intensity of an IV systolic ejection murmur increases when the patient bears down or stands. Non-specific ST and T wave changes with left atrial enlargement are noted. Which of the following is the most likely diagnosis?
Understand the Problem
The question presents a clinical scenario involving a 40-year-old man with chest pain and specific examination findings, asking for the most likely diagnosis based on the provided information.
Answer
Hypertrophic obstructive cardiomyopathy (HOCM).
The final answer is hypertrophic obstructive cardiomyopathy (HOCM).
Answer for screen readers
The final answer is hypertrophic obstructive cardiomyopathy (HOCM).
More Information
Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by an IV systolic ejection murmur that increases with maneuvers that decrease preload, such as standing or the Valsalva maneuver, and often presents with syncope, chest pain, and abnormal ECG findings.
Tips
A common mistake is confusing this with aortic stenosis. In aortic stenosis, the murmur typically decreases when standing.
Sources
- Heart murmurs - Symptoms & causes - Mayo Clinic - mayoclinic.org
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