Patient presents with symptoms suggestive of hypertrophic cardiomyopathy (HCM), including exertional dyspnea, chest pain, palpitations, and presyncope.  Family history is significant for sudden cardiac death, raising concern for genetic HCM.  Physical examination reveals a brisk carotid upstroke and a palpable fourth heart sound.  A systolic ejection murmur may be present, intensifying with Valsalva maneuver.  Electrocardiogram (ECG) demonstrates left ventricular hypertrophy (LVH) and repolarization abnormalities.  Transthoracic echocardiography (TTE) confirms the diagnosis of HCM, showing significant left ventricular wall thickening, typically involving the interventricular septum, with a left ventricular outflow tract (LVOT) gradient.  Differential diagnosis includes athlete's heart, hypertension with LVH, and other cardiomyopathies.  Cardiac magnetic resonance imaging (CMR) may be indicated for further evaluation of myocardial fibrosis and LVOT obstruction.  Genetic testing for HCM-associated mutations is recommended for the patient and potentially family members.  The patient's current New York Heart Association (NYHA) functional class is assessed.  Treatment plan includes beta-blockers or calcium channel blockers for symptom management and to reduce LVOT obstruction.  Surgical myectomy or alcohol septal ablation may be considered for patients with refractory symptoms despite optimal medical therapy.  Patient education focuses on lifestyle modifications, including avoiding strenuous exercise and dehydration, and recognizing symptoms of heart failure exacerbation.  Referral to a cardiologist specializing in HCM is warranted for ongoing management and risk stratification for sudden cardiac death.  ICD implantation may be indicated for high-risk individuals.  Regular follow-up is essential for monitoring disease progression and optimizing treatment strategies.