Which statement best describes the typical presentation of hypertrophic obstructive cardiomyopathy in younger patients?

• A. Less than 35 years old with exertional syncope
• B. Murmur increases with handgrip
• C. Murmur decreases with Valsalva
• D. S3 is present

Answer: (A)

Hypertrophic obstructive cardiomyopathy is a genetic condition where asymmetric septal thickening creates a dynamic obstruction of the left ventricular outflow tract. In younger patients, exertional syncope is a classic presentation because during exercise increased contractility and reduced filling worsen the obstruction, leading to decreased cerebral perfusion and fainting.

The murmur of this condition is a harsh systolic murmur that becomes louder when preload is reduced (standing or Valsalva) and softer when preload is increased (squatting). It does not typically intensify with handgrip, since that maneuver increases afterload and tends to lessen the LVOT obstruction. S3 is not a typical finding; LV hypertrophy can produce a softer S3 is uncommon, whereas S4 may be heard due to a stiff, thickened ventricle.