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

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168416  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

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

## 보기

1. systolic **✔ 정답**
2. diastolic
3. continuous
4. mid-systolic
5. late

**정답: 1**

## 해설

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.

## 임상 시나리오

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

## 핵심 개념

- **systolic** — Relating to or occurring during systole, when the heart muscle contracts and pumps blood from the ventricles
- **diastolic** — Relating to or occurring during diastole, when the heart muscle relaxes and the chambers fill with blood
- **continuous** — A heart murmur that occurs throughout both systole and diastole without interruption
- **mid-systolic** — Occurring during the middle portion of systole, typically heard best during the peak of ventricular contraction
- **late** — Occurring toward the end of a cardiac phase, typically referring to sounds heard near the end of systole or diastole

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