Clinical features
Possible symptoms include:
- angina
- dyspnoea
- palpitations
- syncope
- sudden death
Clinical signs include:
- jerky pulse
- JVP: large a waves, indicating right ventricular flow obstruction
- double impulse at apex
- loud fourth heart sound due to the left ventricular hypertrophy
- third heart sound
- late systolic murmur:
- this is a result of outflow tract obstruction with or without mitral regurgitation
- the murmur is late in systole because some blood must be ejected from the ventricle before the outflow is obstructed
- the murmur is louder during a Valsalva manoeuvre
- the murmur is softer when squatting
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