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I think you have to just go with what is most common, seems like it would be more likely for him to have HTN and atherosclerotic disease than a genetically inherited HOCM (also hes in his 50s which would be a late presentation for HOCM), normal routine treatment for STEMI/NSTEMI is MONA BASH, and NO was the only option that was part of that
I don't think this dude has HOCM - seems more likely that he concentric hypertrophy from the physical exam finding of an S4 (cause undisclosed in question). I agree with the above that he probably wouldn't present this late with HOCM.
To tweak the above a little, eccrine glands are more commonly known as "sweat glands," although sweat glands that are apocrine do exist in the armpits and perineal area, though they do not contribute to cooling.
Per what @melchior said: "Eccrine glands are the major sweat glands of the human body, found in virtually all skin, with the highest density in palm and soles, then on the head, but much less on the trunk and the extremities" - Wiki
Really good observation
Never forget what our lord and savior Dr. Sattar says - environmental trigger in a genetically predisposed individual (aka multifactorial)!