Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy • AD, Peak 5th decade of life, F>M, HTN is a common cause, Could associated with LVOFO or without • Sport → sudden death, Good EF due to hypercontractile state, MR is common • Could be dynamic obstruction by the anterior leaflet of the MV during systole→ systolic anterior motion (SAM). S/S • Angina, Syncope, Arrhythmia,CHF • A.fib→ systemic embolism • Atrial kick very important→ A.fib not well tolerated • CXR→ Cardiomegaly • ECG→ LVH Treatment: • β -blockers 1st choice→ by ↓ HR and contractility→ ↓ outflow obstruction. • CCB is other choice. • CHF is difficult to treat→ digoxin→ ↑ contractility→ ↑ obstruction, diuretics→ hypovolemia→ ↑ obstruction.

•

Myotomy or myomectomy to ↓ outflow obstruction→ improve symptoms but the incidence of sudden death is the same. Anesthesia management: • The main goal is to minimize the LVOFO • Continue pre-op β -blocker therapy. • By: o ↓ contractility→ halothane is a good choice o ↑ preload o ↑ afterload

• • • • • • •

Avoid ketamine for induction Deep induction Avoid histamine releasing drugs Maintain adequate intravascular volume Consider TEE intra-op In case of hypotension use α -agonist, avoid β -agonist → ↑ OFO Maintain sinus rhythm.