Question:
A 15-year-old adolescent presents with exertional syncope. Echocardiogram shows asymmetric septal hypertrophy with LVOT obstruction. Which of the following is the treatment of choice?
A 15-year-old adolescent presents with exertional syncope. Echocardiogram shows asymmetric septal hypertrophy with LVOT obstruction. Which of the following is the treatment of choice?
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HOCM Pharmacology Rules:
$\bullet$ DO GIVE: Beta-blockers (first-line), Non-dihydropyridine CCBs (verapamil).
$\bullet$ DO NOT GIVE: Digoxin (increases inotropy), Diuretics (decreases preload), Vasodilators (decreases afterload) $\rightarrow$ ALL worsen LVOT gradient!
$\bullet$ DO GIVE: Beta-blockers (first-line), Non-dihydropyridine CCBs (verapamil).
$\bullet$ DO NOT GIVE: Digoxin (increases inotropy), Diuretics (decreases preload), Vasodilators (decreases afterload) $\rightarrow$ ALL worsen LVOT gradient!
Updated On: Sep 3, 2026
- Beta blockers
- Nitroprusside
- Diuretics
- Digioxin
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The Correct Option is A
Solution and Explanation
Concept:
Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic disorder of cardiac sarcomere proteins characterized by unexplained left ventricular hypertrophy, predominantly affecting the interventricular septum.
Dynamic left ventricular outflow tract (LVOT) obstruction results from the combination of septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral valve leaflet.
Explanation:
• First-line medical therapy for symptomatic HOCM with LVOT obstruction consists of Beta-blockers (e.g., propranolol, atenolol, metoprolol).
• Beta-blockers exert negative inotropic effects (reducing contractility and lessening SAM) and negative chronotropic effects (prolonging ventricular diastole, allowing better LV filling, and increasing end-diastolic volume), thereby expanding the LVOT and reducing dynamic gradient and exertional symptoms.
• Vasodilators (such as nitroprusside or ACE inhibitors) are strictly contraindicated because decreasing afterload exacerbates dynamic LVOT obstruction.
• Pure diuretics worsen LVOT obstruction by reducing preload and decreasing LV cavity size.
• Positive inotropes like digoxin and dobutamine are strictly contraindicated because increasing contractility worsens the LVOT gradient.
Final Answer:
Beta-blockers are the first-line medical treatment of choice for reducing dynamic LVOT obstruction and symptoms in HOCM.
Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic disorder of cardiac sarcomere proteins characterized by unexplained left ventricular hypertrophy, predominantly affecting the interventricular septum.
Dynamic left ventricular outflow tract (LVOT) obstruction results from the combination of septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral valve leaflet.
Explanation:
• First-line medical therapy for symptomatic HOCM with LVOT obstruction consists of Beta-blockers (e.g., propranolol, atenolol, metoprolol).
• Beta-blockers exert negative inotropic effects (reducing contractility and lessening SAM) and negative chronotropic effects (prolonging ventricular diastole, allowing better LV filling, and increasing end-diastolic volume), thereby expanding the LVOT and reducing dynamic gradient and exertional symptoms.
• Vasodilators (such as nitroprusside or ACE inhibitors) are strictly contraindicated because decreasing afterload exacerbates dynamic LVOT obstruction.
• Pure diuretics worsen LVOT obstruction by reducing preload and decreasing LV cavity size.
• Positive inotropes like digoxin and dobutamine are strictly contraindicated because increasing contractility worsens the LVOT gradient.
Final Answer:
Beta-blockers are the first-line medical treatment of choice for reducing dynamic LVOT obstruction and symptoms in HOCM.
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