Key points for anesthetic and hemodynamic management of patients with hypertrophic cardiomyopathy

Hemodynamic goals	Avoid	Monitor	Intervention
Sinus rhythm	Avoid atrial fibrillation or other SVT	5-lead ECG	Manage new-onset atrial fibrillation or other SVT: Control HR Cardioversion of atrial fibrillation for hemodynamic compromise
Slow to normal HR (60 to 80 bpm)	Avoid tachycardia Avoid severe bradycardia Avoid junctional rhythm	5-lead ECG Pulse oximetry with visible waveform	Prevent tachycardia by ensuring adequate depth of anesthesia and analgesia Manage tachycardia related to hypotension with a vasoconstrictor (eg, phenylephrine, norepinephrine) and fluid administration Slow HR with beta blockers if necessary
Maintain afterload	Avoid hypotension Avoid rapid profound sympathectomy (eg, high spinal)	Intra-arterial blood pressure for major surgical procedures	Administer a vasoconstrictor without inotropic properties (eg, phenylephrine or, if necessary, vasopressin) to prevent and/or manage hypotension
Augment preload	Avoid hypovolemia	Assess clinical response to fluid boluses	Maintain intravascular volume status Rapid resuscitation for hemorrhage
Reduce contractility	Avoid inotropic agents	Hemodynamics	Deepen anesthesia or, if necessary, administer beta blockers

SVT: supraventricular tachycardia; ECG: electrocardiogram; HR: heart rate.

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