Cardiology Clinic

I was working in a cardiology clinic this morning. We saw a patient with asymmetric septal thickening concerning for hypertrophic cardiomyopathy (HCM). I was surprised at how common this condition is. The patient was awaiting genetic testing and thankfully had minimal symptoms. I enjoyed thinking about the interesting physiologic principles relevant to the condition. For instance, the concern of outflow tract obstruction and how it can be precipitated with reductions in preload or afterload. My preceptor and I talked about the value of the physical exam to screen for this. We thought about different murmurs that can be clues. For instance a murmur of mitral regurgitation due to systolic anterior motion of the valve and/or papillary muscle displacement. Should there be outflow tract obstruction we went through the systolic murmur that could result and some maneuvers that would be clues to HOCM: improvement lifting legs when supine and improvement with clenching fists. During my physical exam I thought I heard an S4 sound (another feature consistent with HCM), I was thankful for the opportunity to have my preceptor repeat the physical exam as she agreed with me. It was the first true S4 sound I had heard and having an experienced clinician confirm the finding was critical to my learning. I will have greater confidence in my physical exam skills moving forward because of this encounter. It is a strong argument for the value of observed clinical encounters and bedside teaching.

- MH