Aggrevation of symptoms of angina in a patient when given nitrates is seen in: (A) Aoic regurgitation, (B) Mitral regurgitation, (C) Single left coronary aery stenosis, (D) Idiopathic hyperophic subaoic stenosis
Answer is D. Ref Harrison 19 th ed pg 1568 Idiopathic hyperophic cardiomyopathy ( HOCM) is a dynamic outflow obstruction which is increased by any mechanism decreasing the preload . Nitrates decrease the preload,the volume of blood in LV and thereby increase the dynamic obstruction and symptom of angina