Answer 3 Hypertrophic cardiomyopathy. Systolic ejection murmurs are caused by outflow obstruction. In this case, the obstruction of the outflow tract results from asymmetrical hypertrophy of the ventricular septum. The murmur is worsened with performance of the Valsalva maneuver, because the outflow obstruction is increased. Click here to return to the questions
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