A delicate Balance; Anaesthetic approach to HOCM with Low Ejection Fraction

Abstract

Hypertrophic Obstructive Cardiomyopathy (HOCM) with reduced ejection fraction presents significant anesthetic challenges due to the risk of dynamic LVOT obstruction, arrhythmias, and haemodynamic instability. We report the anaesthetic management of a patient with HOCM and low ejection fraction undergoing laparoscopic cholecystectomy. Emphasis was placed on maintaining preload, avoiding tachycardia, preserving afterload, and blunting sympathetic responses. Invasive monitoring, gentle induction, controlled pneumoperitoneum, and precise intraoperative haemodynamic management enabled a stable perioperative course. This case highlights the importance of individualized anaesthetic strategies in safely managing high-risk cardiac patients undergoing minimally invasive surgery.