Managing left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM)

Hypertrophic cardiomyopathy (HCM), a genetic disorder, commonly results in asymmetric left ventricular hypertrophy, which can lead to obstruction of the left ventricular outflow tract (LVOT) and hypotension under certain conditions.
Factors found to worsen LVOT obstruction (and how to manage):
Tachycardia (maintain sinus rhythm, can use esmolol to decrease HR and promote ventricular filling)
Hypovolemia (maintain left ventricular filling ie with fluid bolus)
Vasodilation (maintain systemic vascular resistance with phenylephrine, a1 adrenergic agonist that increases afterload [and reflex bradycardia also helps])
High chronotropic/inotropic state (reduce sympathetic stimulation)

[@kennethmutumaihuthia1155]

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