A 45-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) has gradient 65 mmHg at rest. He is symptomatic on maximum beta-blocker dose. Which of the following is the NEWEST FDA-approved drug specific to this condition?
- A Disopyramide
- B Mavacamten (cardiac myosin inhibitor) ✓
- C Verapamil
- D Ranolazine
Explanation
Mavacamten (a first-in-class allosteric cardiac myosin inhibitor) was FDA-approved in 2022 for symptomatic obstructive HCM (LVOTO ≥ 30 mmHg) based on the EXPLORER-HCM trial. It reduces LVOT gradient by decreasing excessive myosin-actin cross-bridge formation (the core mechanism of HCM). Mavacamten significantly improved exercise capacity, NYHA class, and quality of life. Disopyramide and verapamil are older agents with modest evidence; disopyramide's negative inotropic effect reduces gradient but has significant anticholinergic side effects. Mavacamten requires echocardiographic monitoring of LVEF due to risk of systolic dysfunction.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.