HCM과 AS에서 murmur가 들리는 위치

전형적 HCM의 murmur는 aortic area (2nd right intercostal area)보다는 left parasternal edge, 4th intercostal space[at the apex and lower left sternal border]에서 잘 들립니다.

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Distinguishing characteristics of the causes of left ventricular outflow tract obstruction

	Valvular	Supravalvular	Discrete subvalvular	Obstructive hypertrophic cardiomyopathy
Pulse pressure after ventricular premature beat	Increased	Increased	Increased	Decreased
Valsalva effect on systolic murmur	Decreased	Decreased	Decreased	Increased
Murmur of aortic regurgitation	Common after age 40	Rare	Sometimes	No
Fourth heart sound (S4)	If severe	Uncommon	Uncommon	Common
Paradoxic splitting	Sometimes*	No	No	Common*
Ejection click	Most (unless valve calcified)	No	No	Uncommon or none
Maximal thrill and murmur	Second RIS	First RIS Suprasternal notch	Second RIS	Fourth LIS
Carotid pulse	Normal to anacrotic* (parvus et tardus)	Unequal	Normal to anacrotic	Brisk, jerky, systolic rebound
Valve calcification	Common after age 40	No	No	No
Dilated ascending aorta	Common after age 40	Rare	Rare	Rare

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RIS: right intercostal space; LIS: left intercostal space.

* Depends upon severity.

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REF. UpToDate 2020.03.08