You know a condition is serious when it causes sudden cardiac death in young athletes and still manages to confuse half the class during cardio lectures. Welcome to Hypertrophic Obstructive Cardiomyopathy (HOCM) — the cardiac equivalent of a dramatic soap opera with murmur twists and pulse plot holes.
To remember the classic clinical findings, meet our eccentric (but unforgettable) mnemonic character:
🧠 Jerky MR. SAM ASH
Yes, sounds like someone who’d sell vintage vinyl records and then faint during a treadmill test. But trust me — this guy will help you dominate HOCM questions on the USMLE/FCPS/MRCP exams and on the wards.
HOCM Mnemonic: Jerky MR. SAM ASH
| Letter/Part | Feature | Explanation |
|---|---|---|
| Jerky | Jerky pulse | Also called “bifid” or “spike-and-dome” pulse due to dynamic outflow obstruction |
| MR | Mitral Regurgitation | Caused by systolic anterior motion of mitral valve leaflet |
| SAM | Systolic Anterior Motion | Of the mitral valve leaflet — a hallmark echo finding |
| ASH | Asymmetrical Septal Hypertrophy | Classic structural hallmark of HOCM; septum > posterior wall |
Clinical commentary from my personal experience
One of my young patients at Sheikh Khalifa Bin Zayed Hospital came in after a syncopal episode post-cricket match. No prior cardiac history, but a suspicious systolic murmur at the left lower sternal border increased with Valsalva.
Echo showed asymmetric septal hypertrophy, with a SAM of the mitral valve, and mild MR.
Pulse? You guessed it — jerky and bifid.
We didn’t need Sherlock — just Jerky MR. SAM ASH. 🕵️♂️💓
😎 Key HOCM Clinical Pearls for the USMLE
- MYH7 mutation
- Murmur increases with Valsalva & standing (↓ preload = ↑ obstruction)
- Murmur decreases with squatting (↑ preload = ↓ obstruction)
- Most common cause: AD mutation in beta-myosin heavy chain or myosin-binding protein-C
- Sudden death risk = arrhythmia + LVOT obstruction
- First-line management: Beta-blockers (slow the heart, reduce obstruction)
Happy learning!
📚 Written by:
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
General Medicine, Gastroenterology & CCU
Sheikh Khalifa Bin Zayed Hospital, Quetta
