From the Guidelines
Yes, a hypertrophic obstructive cardiomyopathy (HOCM) murmur can get louder in the pulmonic area. HOCM typically produces a systolic ejection murmur that is best heard at the left lower sternal border and apex, but it can radiate to the pulmonic area (left upper sternal border) 1. The murmur may become louder in this area due to several factors, including:
- The turbulent blood flow created by the left ventricular outflow tract obstruction can project toward the pulmonic area.
- Certain maneuvers that decrease preload (like standing or Valsalva) can exacerbate the obstruction and intensify the murmur throughout the precordium, including the pulmonic area 1.
- In some HOCM patients, associated mitral regurgitation (due to systolic anterior motion of the mitral valve) can create additional turbulence that may be heard in the pulmonic region. The dynamic nature of HOCM obstruction means the murmur intensity can vary significantly with position changes, exercise, and other physiologic states, potentially making it more prominent in areas beyond its typical location 1. Key points to consider when evaluating a HOCM murmur include:
- Respiration: Right-sided murmurs generally increase with inspiration, while left-sided murmurs usually are louder during expiration 1.
- Valsalva maneuver: The systolic murmur of HOCM usually becomes much louder during the Valsalva maneuver 1.
- Exercise: Murmurs caused by blood flow across normal or obstructed valves become louder with both isotonic and isometric exercise 1.
From the Research
HOCM Murmur Characteristics
- The provided studies do not directly address the question of whether a HOCM murmur can get louder in the pulmonic area 2, 3, 4.
- HOCM is a heterogeneous disease with different clinical presentations, and its treatment approaches have been reviewed in the literature 2.
- The effect of metoprolol on HOCM patients after alcohol septal ablation has been studied, but it does not provide information on the murmur's characteristics 3.
- Another study discusses the comparative metabolism and DNA binding of certain compounds, which is not relevant to the question of HOCM murmur loudness 4.
Relevance of Studies
- The studies provided do not offer any direct evidence or insights into the behavior of HOCM murmurs in the pulmonic area.
- The literature search yielded results focused on treatment approaches, patient selection, and novel techniques for managing HOCM, but not on the specific characteristics of HOCM murmurs 2, 3.