Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of obstructive HCM, including exertional dyspnea (NYHA class [I-IV]), atypical chest pain, and presyncope/syncope. History notable for palpitations and fatigue. No reported orthopnea or PND. Family history positive for sudden cardiac death or HCM.
Clinical Examination Findings
Cardiovascular exam reveals a harsh, crescendo-decrescendo systolic murmur at the left sternal border, increasing with Valsalva maneuver or standing, and decreasing with squatting. Brisk carotid upstroke (bisferiens pulse) noted. Apical impulse is sustained and displaced. Lungs clear to auscultation. No peripheral edema.
Treatment Protocol
Initiate beta-blocker therapy (e.g., Metoprolol succinate) or non-dihydropyridine calcium channel blockers (e.g., Verapamil) for symptom management. Consider disopyramide for refractory obstruction. Advise avoidance of strenuous physical exertion, dehydration, and vasodilators. Evaluate for septal reduction therapy (myectomy or alcohol septal ablation) if obstruction remains symptomatic.