Sudden Death

Hypertrophic Cardiomyopathy 705 Lesson

patient thorax when auscultating by stethoscope

The patient was supine during auscultation.

Description

With hypertrophic cardiomyopathy, we can observe an early peaking, harsh, diamond-shaped systolic murmur. This murmur is present at the beginning of systole and stops well before S2. In diastole, a fourth heart sound gallop is present. The hyperdynamic left ventricle generates increased S1 sound intensity. S2 is single.

On the cardiac animation video, observe that the left ventricle contraction is strong and occurs in a reduced amount of time. The septal wall is significantly thicker than the rest of the ventricle, although this is not depicted in the animation.

The strong contraction of the left ventricle causes the anterior leaflet to be sucked into the ventricle, blocking the flow into the aorta and causing an aortic murmur. Concurrently, turbulent flow from the left ventricle to the left atrium causes a second murmur. Because these two murmurs occur simultaneously, you hear a single murmur.

Observe the difference between the two murmurs by shifting the stethoscope chestpiece from the aortic to the mitral valve area. First, you will hear the diamond-shaped aortic murmur and later the rectangular pansystolic murmur.

Phonocardiogram

Anatomy

Hypertrophic Cardiomyopathy 705

Observing the animation, you can see that the contraction of the left ventricle is strong and occurs in a reduced amount of time. Anatomically, the septal wall is very much thicker than the rest of the ventricle, but this is not shown in the animation.

Authors and Sources

Authors and Reviewers

Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Lung sounds by Diane Wrigley, PA
Respiratory cases: William French
David Lieberman, Audio Engineering
Heart sounds mentorship by >W. Proctor Harvey, MD
Special thanks for the medical mentorship of Dr. Raymond Murphy
Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 11/10/2021

Sources

Heart and Lung Sounds Reference Library Diane S. Wrigley
Publisher: PESI
Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
Diane S Wrigley & Rosale Lobo
Practical Clinical Skills: Lung Sounds
PESI Faculty - Diane S Wrigley
Case Profiles in Respiratory Care 3rd Ed, 2019
William A.French
Published by Delmar Cengage
Essential Lung Sounds by William A. French
Published by Cengage Learning, 2011
Understanding Lung Sounds Steven Lehrer, MD
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
Heart and Lung Sounds Reference Guide
PracticalClinicalSkills.com