A 40-year-old woman presents with progressive dyspnea, pre-syncopal episodes, and a pansystolic murmur that increases with Valsalva (strain phase) and decreases with squatting. Echo shows asymmetric septal hypertrophy (28 mm), systolic anterior motion of the mitral valve, and LVOT gradient 65 mmHg at rest. The pharmacological treatment of choice is:

• A Beta-blocker (metoprolol succinate) or rate-limiting calcium channel blocker (verapamil) ✓
• B Digoxin to improve contractility
• C Vasodilators (nitrates) to reduce preload
• D SGLT2 inhibitor to reduce cardiac steatosis

Explanation

Hypertrophic obstructive cardiomyopathy (HOCM) is treated with beta-blockers or non-dihydropyridine calcium channel blockers (verapamil, diltiazem) as first-line — both reduce heart rate, increase diastolic filling time, and reduce LVOT gradient. Vasodilators and diuretics reduce preload and worsen outflow tract obstruction. Digoxin is contraindicated as its positive inotropy worsens obstruction. Mavacamten (cardiac myosin inhibitor) is a newer approved option for symptomatic HOCM.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.