# Hypertrophic cardiomyopathy in the trauma patient: A case report and review of the literature

## TL;DR

This paper presents a case of a trauma patient with hypertrophic cardiomyopathy and highlights the challenges and management strategies for such patients in trauma care.

## Contribution

The paper introduces a case report and literature review on managing trauma patients with hypertrophic cardiomyopathy, an under-discussed topic.

## Key findings

- HCM patients have worse outcomes after emergent non-cardiac surgeries.
- Phenylephrine is the preferred vasopressor for managing HCM in trauma patients.
- Maintaining a hypervolemic state and lengthening diastolic filling time are critical in HCM trauma care.

## Abstract

Hypertrophic cardiomyopathy (HCM), a prevalent genetic cardiac condition characterized by myocardial thickening, poses unique challenges in trauma care. Sparse evidence seems to agree that HCM patients have worse outcomes following non-cardiac surgeries, particularly emergent procedures. However, despite a prevalence of 1 in 500 in the US population, the intersection of HCM and Advanced Trauma Life Support (ATLS) remains undiscussed in current literature.

A 54-year-old female with unknown past medical history presented as a level 2 trauma alert following a motor vehicle collision. Due to persistent hypotension and transient bradycardia in the trauma bay a further cardiologic evaluation was performed and found severe hypertrophic obstructive cardiomyopathy (HOCM).

We report a case of a polytrauma patient found to have severe HOCM as well as provide a review of the literature including pathophysiological considerations in the management of the trauma patient with HCM.

Caring for the trauma patient with HCM requires a multidisciplinary strategy that integrates advanced cardiac imaging and cautious hemodynamic management, underlining the necessity for heightened awareness.

•It is important to recognize HCM as a contributor to shock in the trauma patient.•HCM patients have worse outcomes following emergent non-cardiac surgeries.•Focus on lengthening diastolic filling time and maintaining a hypervolemic state•Phenylephrine is the preferred vasopressor.

It is important to recognize HCM as a contributor to shock in the trauma patient.

HCM patients have worse outcomes following emergent non-cardiac surgeries.

Focus on lengthening diastolic filling time and maintaining a hypervolemic state

Phenylephrine is the preferred vasopressor.