A 22-year-old man with hypertrophic obstructive cardiomyopathy has a systolic ejection murmur along the left sternal border. Which maneuver will increase the intensity of his murmur?

• A Squatting
• B Passive leg raising
• C Standing from squatting position ✓
• D Handgrip exercise

Explanation

Standing reduces venous return, decreasing left ventricular preload and cavity size, which worsens the dynamic outflow obstruction and increases murmur intensity. Squatting, leg raising, and handgrip all increase preload or afterload, enlarging the ventricular cavity and softening the murmur. This opposite-direction response to loading maneuvers compared with fixed lesions like aortic stenosis is the classic discriminating point examined repeatedly.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.