Increased intensity of the murmur of hypertrophic obstructive cardiomyopathy with carotid sinus pressure.

Abstract:

:In a prospective study murmurs increased in intensity with carotid sinus pressure in 18 of 26 patients with hypertrophic obstructive cardiomyopathy (HOCM) (sensitivity, 69.2 percent for the 26 patients, 85.7 percent for the 21 patients in whom heart rate and blood pressure decreased with carotid sinus pressure). On the other hand, the murmur remained constant or decreased in all but one of 104 patients with valvular aortic stenosis, mitral insufficiency, hypertrophic nonobstructive cardiomyopathy, and systolic murmurs of miscellaneous origins (specificity, 99 percent; positive predictive value, 94.7 percent). Catheterization, indirect arterial pressure tracings, and echocardiographic studies indicated that carotid sinus pressure-induced bradycardia was associated with increased left ventricular outflow tract obstruction. The carotid sinus pressure-induced increase in the murmur is probably multifactorial: decreased aortic pressure and impedance; increased contractility immediately on sudden slowing of heart rate; further increase in obstruction as the mitral valve systolic anterior movement is enhanced; and delayed vasodilatation maintaining the obstruction even after return of heart rate to precarotid sinus pressure values. An increase in a systolic murmur with carotid sinus pressure is characteristic of HOCM.

journal_name

Chest

journal_title

Chest

authors

Klein HO,DiSegni E,Dean H,Beker B,Bakst A,Kaplinsky E

doi

10.1378/chest.93.4.814

subject

Has Abstract

pub_date

1988-04-01 00:00:00

pages

814-20

issue

4

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(16)34547-0

journal_volume

93

pub_type

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