Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing modified radical...

Area of Science:

• Cardiology
• Anesthesiology

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder causing left ventricular outflow tract (LVOT) obstruction.
• Patients may present with diverse symptoms, from asymptomatic to sudden cardiac death.
• Anesthetic management poses challenges due to potential hemodynamic instability.

Observation:

• A 60-year-old patient with a 17-year history of severe HOCM, mitral regurgitation, and prior ventricular tachycardia requiring an implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) was scheduled for mastectomy.
• The patient had an ICD requiring deactivation during surgery with external defibrillation preparedness.
• Key anesthetic considerations included avoiding tachycardia, hypovolemia, vasodilation, and increased cardiac contractility to prevent LVOT obstruction exacerbation.

Findings:

• Successful anesthetic management was achieved, maintaining stable hemodynamics throughout the surgical procedure.
• The patient's ICD was safely managed, with external defibrillation readily available.
• The patient was discharged on the seventh postoperative day, indicating a favorable recovery.

Implications:

• This case highlights the importance of meticulous anesthetic planning and execution in patients with HOCM undergoing non-cardiac surgery.
• Effective management strategies can mitigate risks associated with LVOT obstruction and implanted cardiac devices.
• Successful outcomes are achievable with a multidisciplinary approach and vigilant monitoring.