The nurse auscultates a ______ murmur that becomes louder when the patient squats, suggesting hypertrophic cardiomyopathy.

A systolic murmur that increases with squatting is characteristic of hypertrophic cardiomyopathy. This maneuver increases venous return and afterload, which exacerbates the left ventricular outflow tract obstruction, making the murmur more prominent.

Hypertrophic Cardiomyopathy (HCM):
- Systolic murmur: harsh, crescendo-decrescendo
- Location: left sternal border, apex
- Increases with: Valsalva maneuver, standing
- Decreases with: squatting, handgrip
- Physical findings: S4 gallop, displaced PMI
- ECG: left ventricular hypertrophy, deep Q waves
- Echo: asymmetric septal hypertrophy
- Complications: sudden cardiac death, arrhythmias
- Treatment: beta-blockers, calcium channel blockers
- Inheritance: autosomal dominant

Cardiac Auscultation:
- Systolic murmurs: ejection, regurgitation
- Timing: early, mid, late systolic
- Intensity: grades I-VI
- Quality: harsh, musical, blowing
- Radiation patterns
- Dynamic maneuvers affect intensity
- Position changes alter characteristics
- Associated with specific pathologies
- Differentiation from normal variants
- Correlation with other cardiac findings