A 62-year-old lady with good past health complained of exertional chest discomfort and shortness of breath after five minutes of exercise which was relieved with rest. She also had one episode of unprovoked syncope while having dinner last week. On auscultation Systolic murmur over the left upper sternal border Investigations Resting ECG (Figure attached): Atrial fibrillation with left ventricular hypertrophy by voltage and ST depression over lateral leads Chest X-ray: Cardiomegaly with clear lung field Echocardiogram: Asymmetric septal hypertrophy (Interventricular septal thickness 2.2 cm) with an elevated gradient across left ventricular outflow tract (resting maximum gradient 92 mm Hg), compatible with hypertrophic obstructive cardiomyopathy (HOCM) CT coronary angiogram: Mild coronary stenosis Which medication should be avoided in this condition? A.
Beta-blocker B. Aspirin C. Nitrate…
