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Figure 5 The 24-h ECG recordings from patients with HCM and varying degrees of beta-receptor blockade. (A) A 24-h ECG trace from 9-month-old infant with severe HCM before starting therapy. (B) Same infant on 5 mg/kg/day of propranolol; maximum heart rate is lower, but still up to 140 beats/min, and there is considerable variability. (C) Same infant, after serial increases to a dose of 20 mg propranolol/kg/day in order to abolish a dynamic outflow gradient, now shows good beta-blockade, with awake heart rates mostly between 90 and 110 beats/min. (D) A young adult, with HCM first diagnosed at age 13 years, now on 14 mg/kg of propranolol/day. Despite the very flat heart rate response (between 60 to 70 beats/min) she has no problems coping with full-time employment.
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