# 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=168417  
> 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

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

## 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 in the middle portion of systole, during the heart's contraction phase
- **late** — Occurring near the end of a cardiac cycle phase, typically referring to the latter part of systole or diastole

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