Hypertrophic Obstructive Cardiomyopathy and Pregnancy: A Clinical Case Series

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) is a primary myocardial disorder caused by mutations in several different genes coding for contractile proteins. Although HOCM is being increasingly diagnosed in women of reproductive age due to widespread use of echocardiography and screening programs, there are fewer studies of HOCM in pregnancy owing to the rarity of the disease and poor recognition. Our clinical case series includes five cases of hypertrophic cardiomyopathy and its management. The authors describe five women presenting with HOCM with varied symptoms. All patients except one had favorable outcome. Neonatal outcome was good except for a second trimester intrauterine fetal demise. Intensive care unit (ICU) requirement ranged from 5 to 10 days. Two cases were established cases of HOCM. Pain relief was adequate with narcotics, although regional anesthesia was given to one with HOCM with corrected obstruction. No hypotension or deterioration was noted. Although it is believed that HOCM is well tolerated in pregnancy, it is important to have the diagnosis since management differs. Inadvertent regional anesthesia or hypotension due to blood loss or heightened sympathetic response to pain may prove detrimental to these patients. Maternal and fetal outcome are good. Prenatal routine echocardiography screening may prove efficient in identifying high-risk women, for early referral and better management.