Unique Approach to Management of Hypertrophic Obstructive Cardiomyopathy within a Resource-Limited Hospital

Abstract

LVOT obstruction in HCM results from systolic anterior motion (SAM) of the anterior leaflet of the mitral valve and is often a dynamic process (increasing with volume depletion and decreases with volume repletion or afterload augmentation). Hence, understanding the underlying pathophysiological process is crucial in tailoring management decisions. We herein present a case of a 57-year-old female who presented to the emergency department with complaints of shortness of breath (SOB), cough and borderline blood pressure who further decompensated during hospital course, suffering from acute hypotension related to dynamic LVOT obstruction. The patient was managed with a pure α-agonist, phenylephrine. This case report highlights the importance of having a high index of suspicion to early recognize such dynamic LVOT obstruction and further highlights the uniqueness of managing symptomatic hypotension in HCM with LVOT obstruction in an under-resourced hospital.