Question

Which murmur increases on standing?

• A. HOCM
• B. VSD
• C. MR
• D. MS

Answer 1

The Correct Option is A

In the context of cardiac murmurs and their dynamic auscultation, standing up affects the venous return to the heart and can influence the intensity of certain murmurs. The options provided include:

• HOCM (Hypertrophic Obstructive Cardiomyopathy): In HOCM, the murmur is due to a dynamic obstruction in the left ventricular outflow tract. When a person stands, venous return decreases, which reduces the preload. This results in an increased obstruction and louder murmur.
• VSD (Ventricular Septal Defect): Midsystolic murmurs, like those caused by VSD, typically become less audible when venous return decreases.
• MR (Mitral Regurgitation): Mitral regurgitation murmurs are usually unaffected or become quieter with a decrease in preload since there is less volume in the left atrium and ventricle.
• MS (Mitral Stenosis): Being a diastolic murmur, its intensity does not increase significantly on standing.

Therefore, the murmur that characteristically increases in intensity when standing is associated with Hypertrophic Obstructive Cardiomyopathy (HOCM).