A 59 year old woman presented with exertional dyspnoea and presyncope. Cross sectional and Doppler echocardiography revealed asymmetric septal hypertrophy, systolic anterior movement of the anterior mitral leaflet, and left ventricular outflow obstruction with a pressure gradient of 140 mm Hg. She was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM), and had been treated with …