Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with [exertional dyspnea/angina/presyncope/syncope]. Symptoms are exacerbated by physical exertion and relieved by rest. No history of sustained palpitations or documented arrhythmias. Current functional status is NYHA Class [I/II/III/IV]. No reported orthopnea or PND.
Clinical Examination Findings
Cardiovascular exam reveals a harsh, crescendo-decrescendo systolic ejection murmur at the left sternal border, increasing in intensity with Valsalva maneuver and standing, and decreasing with squatting. Carotid upstroke is brisk/bisferiens. Point of Maximal Impulse (PMI) is sustained and displaced. No peripheral edema or JVD noted.
Treatment Protocol
Initiate/Continue [Beta-blocker/Non-dihydropyridine CCB] for symptom management and outflow tract gradient reduction. Avoid dehydration and strenuous isometric exercise. Consider disopyramide for refractory symptoms. Evaluate for septal reduction therapy (myectomy or alcohol septal ablation) if gradient remains >50 mmHg despite maximal medical therapy.