Intraoperative diagnosis of hypertrophic cardiomiopathy

Abstract

Hypertrophic cardiomyopathy (HCM) is the most com- mon genetic disease of the heart. Autosomal dominant inheritance leading to mutation in one of the numerous genes encoding for proteins in the myocardial sarcomere leads to abnormal myocyte growth with hypertrophy. As the process generally remains asymptomatic during the early phases, diagnosis is frequently made when the pa- tient or a close relative manifests clinical signs and symp- toms such as chest pain, arrhythmias or sudden cardiac death. We present a 16-year-old adolescent who pre- sented for anesthetic care during repair of a fractured fib- ula. Intraoperatively, electrocardiographic (ECG) abnor- malities were noted leading to the diagnosis of HCM. The differential diagnosis of intraoperative ECG changes is discussed and a diagnostic algorithm presented.

Keywords

• hypertrophic cardiomyopathy; st segment changes; car- diac arrest; pediatric anesthesia