hypertrophic cardiomyopathy (HCM) vs aortic stenosis (AS)

Differential diagnosis

• carotid pulse
  • HCM: pulsus bisferiens; pulse rises, then declines, then rises again
  • AS: pulsus parvus, pulsus tardus; pulse slow to rise with low volume
• ejection murmur
  • HCM: heard best at left lower sternal border
  • AS: heard best at right upper sternal border
• aortic insufficiency
  • HCM: none
  • AS: may be present
• Valsalva maneuver
  • HCM: increases murmur
  • AS: no change or decreased murmur
• squatting vs standing
  • HCM: standing increases murmur, squatting decreases murmur
  • AS: no change or standing decreases murmur, squatting increases murmur
• radiation to carotids
  • HCM: none
  • AS: generally present
• apex beat
  • HCM: 'triple ripple'
  • AS: sustained single beat

HCM = hypertrophic cardiomyopathy AS = aortic stenosis