Hypertrophic Cardiomyopathy — EECC MCQ

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ModerateCardiomyopathyHypertrophic CardiomyopathyEECC

A 45-year-old man with hypertrophic cardiomyopathy (maximum wall thickness 22 mm, LVEF 65%) has NYHA class III symptoms despite maximally tolerated bisoprolol. He has a resting LVOT gradient of 65 mmHg. What pharmacological therapy should be considered next?

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Correct answer: A — Mavacamten

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

Per the 2023 ESC Cardiomyopathy Guidelines, mavacamten (a cardiac myosin inhibitor) should be considered in patients with obstructive HCM who remain symptomatic despite beta-blocker therapy (Class IIa), based on EXPLORER-HCM and VALOR-HCM trials. Disopyramide (B) is also an option but mavacamten has a stronger evidence base. Diltiazem/verapamil (A, D) are second-line alternatives, not add-on therapy. Amiodarone (E) is for arrhythmia management.

Reference: ESC (2023): Guidelines for the Management of Cardiomyopathies