Qbank q systolic ejection murmur - nida

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A 67-year-old man presents to the emergency department complaining of dyspnea, chest pain, and several recent episodes of post-exertional syncope. On examination there is a sustained apical impulse, a loud S4, and systolic ejection murmur. An echocardiogram shows anterior motion of the mitral valve during systole, asymmetric left ventricular hypertrophy, and early closing followed by reopening of the aortic valve. Which of the following is the most appropriate initial treatment for this patient?
A. Bretylium
B. Digoxin
C. Enalapril
D. Lidocaine
E. Metoprolol