suvi21
Forum Junior
Topics: 6
Posts: 81
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A 23 yrs old male came to the physician with complaints of chest pain and shortness of breath and syncope. The patient gave the history that these conditions were aggravated by exercise. On examination the patient had following findings: double impulse at the apex, mid systolic murmer at the base of heart Jerky pulse, Palpable left ventricular hypertrophy, Pansystolic murmer at mitral area
Which of the following drug can be given to the patient to relieve his symptoms
a; captopril
b; nitroglycerin
c; hydralazine
d; atenolol
e; digoxin
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| dariush
Forum Elite
Topics: 20
Posts: 356
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the guy has Mitral Regurg. with severe Second. Pulm. Hypertension.
i guess Hydalazine would be useful to reduce the Pulm. art. resistance
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Allah (God) is watching over us...
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| drdk76
Forum Newbie
Topics: 2
Posts: 21
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hi !! i think this is a case of HOCM-hypertrophic obstructive cardiomyopathy--jerky pulse,double apical impulse,midsystolic murmur at the base are characteristic- MR--causing PSM is also present in hocm.physical exertion can aggravate symptoms --may lead to sudden death.as with treatment DOC --is b-blocker. calcium channel blockers can be used.amiodarone prevents SVT.digitalis,diuretics,nitrates,dilators like ACEI are contraindicated.hence the correct choice would be atenolol
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| docface
Forum Senior
Topics: 23
Posts: 56
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YES I AGREE, double apex beat is classical of HOCM, and the reason for MR murmer is systolic anterior motion or mitral anterior leaflet, and these patients are at high risk of sudden death, and atenolol prevents sudden death by unkown mechanism.
Hope this clarifies things.
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| suvi21
Forum Junior
Topics: 6
Posts: 81
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drdk and docface correct 
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