Due to increased LV oxygen demand and reduced coronary flow reserve
Impaired ventricular filling during diastole results in a reduced stroke volume. Compensatory tachycardia maintains cardiac output but tachycardia is associated with a shortened diastole, thereby reducing the coronary filling time. The hypertrophic LV also compresses the coronary arteries, further reducing the coronary reserve.
Dizziness and syncope
Auscultation
Harsh crescendo-decrescendo (diamond-shaped), late systolic ejection murmur that radiates bilaterally to the carotids
Best heard in the 2nd right intercostal space
Handgrip decreases the intensity of the murmur.
Valsalva and standing from squatting decreases or does not change the intensity of the murmur (in contrast to hypertrophic cardiomyopathy).
Soft S2
A soft S2 results from a delay in the aortic component (A2) and softer closing of the aortic valve due to reduced mobility.
S4 is best heard at the apex.
Because of decreased compliance of the LV
Early systolic ejection click
Results from the abrupt stop of the valve leaflets upon opening