Question: why does mitral valve prolapse murmur increases with valsalva?
Answer: Patients with HCM who Valsalva are pushing blood through an even smaller ventricular space and outflow tract which increases turbulence. In short, Valsalva increases the systolic ejection murmur of HCM. Additionally, low-flow states move the click of mitral valve prolapse earlier in systole (i.e. closer to S1).