A 68-year old man who has had a recent syncopal episode is hospitalized with congestive hea failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a dispropoionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man :

Answer is B (Decrease of murmur with handgrip) The murmur decreases with increase in ventricular volume during.isometric exercise (handgrip) Echocardiographic evidence of dispropoionately thickened ventricular septum and systolic anterior motion (SAM) of mitral valve strongly suggests Idiopathic hyperophic Subaoic stenosis. The Typical harsh systolic murmur does not radiate to carotid aeries and decreases with increase in ventricular volume during isometric exercise (handgrip). Congestive hea failure often occurs because of reduced ventricular compliance despite normal ventricular systolic function. The carotid upstroke is brisk and often bifid.