These medications also decrease the heart rate, though their use in people with severe outflow obstruction, elevated pulmonary artery 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 further 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 hypertrophic cardiomyopathy who do not respond to fluid administration.Mavacamten was approved for medical use in the United States in April 2022. Surgical septal myectomy
Surgical septal myectomy is an open-heart operation done to relieve symptoms in people who remain severely symptomatic despite medical therapy. It has been performed successfully since the early 1960s. Surgical septal myectomy uniformly decreases left ventricular outflow tract obstruction and improves symptoms, and in experienced centers has a surgical mortality of less than 1%, as well as 85% success rate. It involves a median sternotomy (general anesthesia, opening the chest, and cardiopulmonary bypass) and removing a portion of the interventricular septum.
Mediastinal lymphadenopathy or mediastinal adenopathy is an enlargement of the mediastinal lymph nodes. Causes
There are many possible causes of mediastinal lymphadenopathy, including: 

Tuberculosis
Sarcoidosis
Lung cancer/oesophageal cancer
Lymphangitis carcinomatosa
Cystic fibrosis
Histoplasmosis
Acute lymphoblastic leukemia
Coccidioidomycosis
Lymphoma
Whipples disease
Goodpasture syndrome
Hypersensitivity pneumonitisInflammatory response to Silicone (leaked from ruptured implants) which has migrated and collected in mediastinal lymph nodes. Silicone mediastinal lymphadenopathy. See also
Lymphadenopathy
Mediastinum
Mediastinal lymph node
Mediastinal mass
Neoplasia


== References ==