A patient with hypertrophic obstructive cardiomyopathy presenting for total knee replacement

Abstract

A 72-year-old woman with a history of hypertrophic obstructive cardiomyopathy (HOCM) was listed for a left total knee replacement (TKR). She had had an uneventful general anaesthetic (GA) for a knee arthroscopy 4 years earlier but had been refused TKR because she was a high anaesthetic risk. She now presented with pain that was keeping her awake at night and was keen for surgery, being fully aware of the attendant risks. She had a strong family history of HOCM and had had one episode of self-terminating fast atrial fibrillation. Her current medication was aspirin 75 mg, amiodarone 100 mg twice daily and atenolol 25 mg once daily.