Hypertrophic cardiomyopathy is associated with a systolic murmur loudest at the apex, and it may radiate to the base. The murmur increases with maneuvers that cause ventricular filling to decrease (e.g. valsalva, standing). The murmur decreases with maneuvers that cause ventricular filling to increase (e.g. trendelenburg, isometric exercises, squatting). These patients have primarily diastolic dysfunction, and so they should be treated with beta blockers to help improve diastolic filling time.
