Importance of Recognizing Hypertrophic Cardiomyopathy in the Preoperative Clinic.

Background: Hypertrophic cardiomyopathy is a relatively common inherited disorder that may be asymptomatic. It is a common cause of sudden cardiac death and can lead to catastrophic cardiovascular collapse in the operating room if previously undiagnosed. This case report discusses the implications of unsuspected hypertrophic cardiomyopathy for anesthesia management.

Case presentation: A veteran aged 55 years presented to the preadmission testing clinic prior to undergoing outpatient surveillance colonoscopy under anesthesia. His initial medical history was unremarkable. On physical examination, a murmur with benign characteristics was detected. However, further evaluation with echocardiography, revealed severe hypertrophic obstructive cardiomyopathy. The patient was ultimately referred for septal myectomy consideration.

Conclusions: Hypertrophic cardiomyopathy is a relatively common disorder that often remains undiagnosed. This condition has critical implications for preoperative evaluation, as patients with this disorder may develop sudden, unexpected, and refractory hypotension upon induction of anesthesia.