THE CONTEXT
The clinical feature list combines exertional symptoms, characteristic cardiovascular signs and factors that augment signs of outflow obstruction.
Symptoms
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Exertional symptoms: Angina, dyspnoea and syncope occur on effort.
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Sudden death: This is included among the clinical presentations.
Cardiovascular examination
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Pulse: The arterial pulse is jerky.
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Palpation: Left ventricular hypertrophy may be palpable.
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Apical impulse: A double impulse at the apex represents a palpable fourth heart sound attributed to left atrial hypertrophy.
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Basal murmur: A mid-systolic murmur is heard at the base.
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Apical murmur: Mitral regurgitation produces a pansystolic murmur at the apex.
Augmentation of outflow obstruction signs
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Standing: Reduced venous return on standing may augment signs of left ventricular outflow tract obstruction.
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Drug effects: Inotropes and vasodilators may also augment these signs.