A Palpable Puzzle

🗒️ Question 

A 47 year old man presents to the cardiology clinic with a history of exertional dyspnoea, occasional palpitations and three episodes of syncope over the past six months. His physical examination reveals a harsh systolic murmur best heard at the left sternal edge which becomes more pronounced with Valsalva manoeuvre.

An ECG reveals left ventricular hypertrophy with deep Q waves in the anterolateral leads. Echocardiography shows asymmetric septal hypertrophy and no significant left ventricular outflow tract obstruction. His father and paternal uncle both died suddenly in their 40s.

What is the most likely diagnosis?

(A) Dilated cardiomyopathy
(B) Hypertrophic cardiomyopathy
(C) Cardiac amyloidosis
(D) Fabry disease
(E) Sarcoidosis