We describe a 62-year-old male patient.Transthoracic Echocardiography(TTE)showed asymmetrical septal hypertrophy and a variable pressure gradient across the left-ventricular outflow tract.There was a resting gradient of 53 mmHg rising to 70 mmHg during the valsalva maneuver.and slight mitral incompetence.He had been diagnosed with hypertrophic obstructive cardiomyopathy and were refractory to medical treatments.