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.

Key Learning Points:

1. Hypertrophic Cardiomyopathy (HCM):
- Characterized by left ventricular hypertrophy
- Causes obstruction of left ventricular outflow tract
- Inherited autosomal dominant condition
- Common cause of sudden cardiac death in young athletes

2. Systolic Murmur Characteristics:
- Crescendo-decrescendo quality
- Best heard at left sternal border
- Radiates to carotid arteries
- Increases with Valsalva maneuver
- Decreases with standing

3. Physical Maneuvers Affecting Murmur:
- Squatting: increases murmur intensity
- Standing: decreases murmur intensity
- Handgrip: increases murmur intensity
- Valsalva: increases murmur intensity

4. Associated Symptoms:
- Dyspnea
- Chest pain
- Syncope
- Exercise intolerance
- Palpitations

5. Diagnostic Methods:
- Echocardiography
- ECG shows left ventricular hypertrophy
- Cardiac MRI
- Genetic testing