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hypertrophic cardiomyopathy (HCM) vs aortic stenosis (AS)
Differential diagnosis:
- carotid pulse
a) HCM: pulsus bisferiens; pulse rises, then declines, then rises again
b) AS: pulsus parvus, pulsus tardus; pulse slow to rise with low volume
- ejection murmur
a) HCM: heard best at left lower sternal border
b) AS: heard best at right upper sternal border
- aortic insufficiency
a) HCM: none
b) AS: may be present
- Valsalva maneuver
a) HCM: increases murmur
b) AS: no change or decreased murmur
- squatting vs standing
a) HCM: standing increases murmur, squatting decreases murmur
b) AS: no change or standing decreases murmur, squatting increases murmur
- radiation to carotids
a) HCM: none
b) AS: generally present
- apex beat
a) HCM: 'triple ripple'
b) AS: sustained single beat
HCM = hypertrophic cardiomyopathy AS = aortic stenosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022