A 20-year-old man comes to the clinic for a routine physical examination. The patient has no medical problems and takes no medication. He does not use tobacco, alcohol, or illicit drugs. He plays on his college football team and participates in intense training sessions and weekly games. Review of systems is unremarkable. Blood pressure is 120/76 mm Hg, pulse is 68/min, and respirations are 15/min. BMI is 28 kg/m. Blood pressures in the upper and lower extremities are equal. There is no jugular venous distension. Carotid upstrokes are brisk. There is a grade 2/6 early systolic murmur along the left sternal border. The murmur decreases in intensity with hand grip and passive leg elevation. Which of the following medications should be avoided while treating this patient's condition?

Question

A 20-year-old man comes to the clinic for a routine physical examination. The patient has no medical problems and takes no medication. He does not use tobacco, alcohol, or illicit drugs. He plays on his college football team and participates in intense training sessions and weekly games. Review of systems is unremarkable. Blood pressure is 120/76 mm Hg, pulse is 68/min, and respirations are 15/min. BMI is 28 kg/m. Blood pressures in the upper and lower extremities are equal. There is no jugular venous distension. Carotid upstrokes are brisk. There is a grade 2/6 early systolic murmur along the left sternal border. The murmur decreases in intensity with hand grip and passive leg elevation.   Which of the following medications should be avoided while treating this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy worsens with decreased left ventricular blood volume.  Therefore, medications that decrease preload (eg, nitrates), afterload (eg, hydralazine), or both (eg, dihydropyridine calcium channel blockers, ACE inhibitors) should be avoided.

A 20-Year-Old Man Comes to the Clinic for a Routine