Evaluation and management of hypertrophic cardiomyopathic patients through noncardiac surgery and pregnancy

Due to the prevalence of hypertrophy cardiomyopathy (HCM) (1:500), anesthesiologists, cardiologists, surgeons and obstetricians will encounter these patients and need to thoroughly understand their disease in order to understand the risk that noncardiac surgery and pregnancy imposes upon them. Patients with HCM have genotypic and phenotypic variability. Indeed a subgroup of these patients exhibits the HCM genotype but not the phenotype (left ventricular hypertrophy). There are a number of treatment modalities for these patients including pharmacotherapy to control symptoms, implantable cardiac defibrillators to manage malignant arrhythmias, and surgical myectomy and alcohol septal ablation to decrease the left ventricular hypertrophy and outflow obstruction. In this chapter, we will discuss how management of these patients perioperatively is vital to improving their survivability and morbidity when they undergo noncardiac surgery, either electively or emergently. We will also discuss the peripartum management of the HCM patient since the physiologic changes of pregnancy can have either a salubrious or detrimental effect on the pathophysiology of HCM.