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Paradoxical increase in left ventricular outflow obstruction after verapamil. Increase in the left ventricular outflow tract (LVOT) gradient after a verapamil-induced marked fall in systemic arterial blood pressure (BP). PCW = mean pulmonary capillary wedge pressure; HR = heart rate. Reproduced with permission from Epstein SE, Rosing DR. Verapamil: Its potential for causing serious complications in patients with hypertrophic cardiomyopathy. Circulation 1981; 64: 437-41.
