Drug of choice in HOCM ?

BETA BLOCKERS ARE THE FIRST LINE DRUGS IN HOCM The primary goal of medications is to relieve symptoms such as chest pain, shoness of breath, and palpitations. Beta blockers are considered first-line agents, as they can slow down the hea rate and decrease the likelihood of ectopic beats. For people who cannot tolerate beta blockers, nondihydropyridine calcium channel blockers such as verapamil can be used, but are potentially harmful in people who also have low blood pressure or severe shoness of breath at rest. These medications also decrease the hea rate, though their use in people with severe outflow obstruction, elevated pulmonary aery wedge pressure, and low blood pressures should be done with caution. Dihydropyridine calcium channel blockers should be avoided in people with evidence of obstruction. For people whose symptoms are not relieved by the above treatments, disopyramide can be considered for fuher symptom relief. Diuretics can be considered for people with evidence of fluid overload, though cautiously used in those with evidence of obstruction. People who continue to have symptoms despite drug therapy can consider more invasive therapies. Intravenous phenylephrine (or another pure vasoconstricting agent) can be used in the acute setting of low blood pressure in those with obstructive hyperophic cardiomyopathy who do not respond to fluid administration. Ref Harrison 20th edition pg 1523