Which medication is least likely to affect vascular perfusion in hypertrophic cardiomyopathy?

Etomidate is the least likely medication to affect vascular perfusion in patients with hypertrophic cardiomyopathy. This is primarily because etomidate is an ultra-short-acting anesthetic with minimal cardiovascular effects. It primarily acts as a sedative and has a neutral profile regarding hemodynamic stability, making it less impactful on the heart and vascular system compared to the other options.

In contrast, the other medications listed have varying cardiovascular effects that could potentially influence vascular perfusion. For example, amiodarone is an antiarrhythmic that can affect heart rate and blood pressure, especially in patients with structural heart disease. Metoprolol is a beta-blocker that reduces heart rate and myocardial oxygen demand but may also alter vascular dynamics, which can be critical in hypertrophic cardiomyopathy patients who rely on adequate perfusion for cardiac function. Adenosine, while it can be used to manage arrhythmias, can cause transient vasodilation and alteration in heart rate, which might negatively affect perfusion in certain scenarios.

Therefore, etomidate’s minimal cardiovascular effects and its sedative properties make it the preferable choice regarding preserving vascular perfusion in the context of hypertrophic cardiomyopathy.