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For patients who have symptoms of heart failure (HF) and left ventricular outflow tract (LVOT) obstruction, we recommend initial monotherapy with a negative inotropic agent (beta blocker, nondihydropyridine calcium channel blocker, or disopyramide) (Grade 1B). Vasodilators and diuretics should be used with caution or avoided in patients with significant LVOT obstruction, given the possibility of worsening LVOT obstruction and symptoms.
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