A 14-Year-Old Boy Is Brought to the Office for Evaluation

A 14-year-old boy is brought to the office for evaluation after his father experienced sudden cardiac arrest during a hiking trip.  The boy has no symptoms or known chronic medical conditions.  Blood pressure is 110/60 mm Hg and pulse is 75/min.  Physical examination shows a supple neck with no jugular venous distension.  The carotid pulse has a dual upstroke.  There is strong apical impulse, and a faint midsystolic murmur is best heard at the cardiac apex and along the left sternal border.  The lungs are clear to auscultation.  Which of the following maneuvers is most likely to increase the murmur intensity in this patient?

A) Squatting
B) Supine leg raise
C) Supine position from standing
D) Sustained handgrip
E) Valsalva strain phase

Correct Answer:

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