Hypertrophic obstructive cardiomyopathy

A 40-year-old woman presents with syncope occurring during physical activity. She has a family history of hypertrophic obstructive cardiomyopathy. On examination, a systolic murmur is heard at the left sternal border, which increases with standing and decreases with squatting. An echocardiogram confirms hypertrophic obstructive cardiomyopathy with significant septal hypertrophy.

What is the definitive treatment option for patients with symptomatic hypertrophic obstructive cardiomyopathy who are refractory to medical therapy?

A 50-year-old man diagnosed with hypertrophic obstructive cardiomyopathy presents with worsening shortness of breath and significant chest pain. His symptoms have progressively worsened over the past few weeks, and his physician decides to initiate immediate management to stabilize his condition.

What is the most appropriate initial short-term management for this patient with hypertrophic obstructive cardiomyopathy?

A 28-year-old man is referred for evaluation after his brother died suddenly while playing football. He has been asymptomatic but is concerned about his own risk. On physical examination, a systolic ejection murmur is noted, which increases with the Valsalva manoeuvre. An ECG shows left ventricular hypertrophy with deep T-wave inversions. An echocardiogram reveals asymmetric septal hypertrophy with a significant LVOT gradient.

What is the most appropriate next step in managing this patient?

A 40-year-old woman presents with episodes of dizziness and palpitations. On physical examination, there is a systolic ejection murmur that increases with the Valsalva maneuver. The physician suspects hypertrophic obstructive cardiomyopathy and decides to confirm the diagnosis.

Which of the following investigations is most appropriate for confirming the diagnosis of hypertrophic obstructive cardiomyopathy?

A 32-year-old male presents to the clinic with exertional dyspnoea, chest pain, and occasional palpitations. He mentions that his father died suddenly at the age of 45. On examination, a harsh systolic murmur is heard at the left sternal border, which increases with the Valsalva manoeuvre. An echocardiogram shows asymmetric septal hypertrophy with a left ventricular outflow tract (LVOT) gradient of 40 mmHg.

What is the most appropriate initial pharmacological treatment for this patient?