A 35-year-old farmer consulted a local medical practitioner for recurrent attacks of chest pain. His elder brother had similar complaints and had died suddenly at the age of 40 years. The farmer was advised to take nitroglycerine sublingually at the time of pain. However, the patient finds that the intensity of pain is increased by nitroglycerine. Most probably, he is suffering from :

**Core Concept**
The patient's condition is characterized by abnormal coronary artery vasomotor tone, leading to episodic myocardial ischemia. This condition is often associated with a positive family history, suggesting a genetic predisposition.

**Why the Correct Answer is Right**
In patients with variant (Prinzmetal's) angina, coronary artery spasm is triggered by endothelial dysfunction and an imbalance between vasodilators and vasoconstrictors. Nitroglycerine, a vasodilator, would typically relieve chest pain by reducing myocardial oxygen demand. However, in this patient, nitroglycerine paradoxically worsens the pain by inducing further coronary artery spasm. This is likely due to the nitrate's ability to reduce preload, which can lead to a reflex increase in sympathetic tone and subsequent coronary artery vasoconstriction.

**Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because it does not explain the paradoxical response to nitroglycerine in this patient. The patient's symptoms and family history are more suggestive of variant angina.
- **Option B:** This option is incorrect because it does not account for the patient's increased pain with nitroglycerine. The typical response to nitrates in variant angina is vasodilation, not vasoconstriction.
- **Option C:** This option is incorrect because it does not accurately describe the patient's condition. The patient's symptoms and family history are more suggestive of variant angina, not stable angina.

**Clinical Pearl / High-Yield Fact**
In patients with variant angina, the use of long-acting nitrates can lead to tolerance and a paradoxical increase in coronary artery spasm. This highlights the importance of carefully monitoring patients with variant angina and adjusting treatment accordingly.

**Correct Answer:** C. Variant angina is characterized by chest pain that is typically relieved by nitroglycerine, but in this patient, the pain is increased by nitroglycerine due to a paradoxical response.

✓ Correct Answer: B. Hyperophic obstructive cardiomyopathy.