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cardiac
High-impact pattern
Hypertrophic Cardiomyopathy (HCM) — Perioperative Anesthetic Management
Dynamic LVOT obstruction: keep the ventricle full, slow, and vasoconstricted
HCM is a dynamic, preload- and afterload-dependent LVOT obstruction — anesthetic goals are full preload, slow heart rate, maintained afterload, and avoidance of inotropes or vasodilators.
If you forget
FULL, SLOW, TIGHT: keep LV full, rate slow, SVR up — opposite of AS
Board trap
Question gives a patient on chronic metoprolol undergoing cholecystectomy — the trap is 'hold the beta-blocker preop.' Wrong. AHA/ACC 2024 says CONTINUE beta-blockers and non-DHP CCBs without interruption in HCM.
Key numbers
- MAP goal ≥ 60-65 mm Hg (AHA/ACC 2024 perioperative target)
- Systolic BP goal ≥ 90 mm Hg intraop
- Phenylephrine: 50-200 mcg IV bolus, then 10-100 mcg/min infusion
- Vasopressin: 0.5-2 U IV bolus, then 0.04 U/min infusion
- Esmolol: 0.5 mg/kg IV bolus, then 50-200 mcg/kg/min
- Mid-to-late systolic late-peaking velocity curve on Doppler = dynamic LVOT obstruction
Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · AHA ACC Perioperative Cardiovascular 2024 · ASE EACVI Aortic Stenosis 2017
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: hcm · Path: aba.cardiac.heart-failure-cardiomyopathy.hcm