What physical exam finding is typical in patients with hypertrophic cardiomyopathy?

In hypertrophic cardiomyopathy (HCM), a bisferiens carotid pulse is a characteristic finding. This pulse is noted for its dual systolic peaks when palpated, which reflects the rapid rise and fall of pressure in the arterial system due to the dynamic obstruction of blood flow caused by the hypertrophied heart muscle. This obstruction can lead to a quick initial rise in stroke volume, followed by a rapid decrease, resulting in two distinct peaks felt during the carotid pulse.

In contrast, bilateral lung crackles, hepatojugular reflux, and jugular venous distension are more commonly associated with conditions that involve heart failure or fluid overload, rather than the specific dynamic changes seen in hypertrophic cardiomyopathy. Thus, the bisferiens pulse is a distinctive and important physical finding that helps in recognizing HCM, differentiating it from other cardiovascular conditions.