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nonobstructive HCM, the thickened left ventricle reduces ventricular size, with resultant stiffness reducing left ventricular end-diastolic volume. Particularly in hypertrophic obstructive cardiomyopathy, decreased preload and afterload and increased myocardial contractility can worsen LVOT obstruction and cause decreased cardiac output. 6 Therefore, stabilization of circulatory dynamics is critical in anesthetic management. In this report, we describe compromised circulatory management during general anesthesia in a patient with nonobstructive HCM taking digitalis

Drugs that act directly on the heart can influence any of 3 cardiac activities, including contractility (force), rate, and intrinsic neural conduction. A number of mechanisms can be exploited but the most familiar are those that mimic or inhibit autonomic innervations to the heart. For example, anticholinergic agents and beta-adrenergic agonists increase most cardiac functions. It must be pointed out, however, that many additional drugs can influence cardiac function by mechanisms that are unrelated to autonomic innervations. Digitalis

 month of age. He was diagnosed with LVNC and chronic heart failure at 4 months. The patient was taking alpha‐ and beta‐blockers, an angiotensin‐converting enzyme (ACE) inhibitor, digitalis, and diuretics. He was sedentary in daily life. Climbing stairs, running, or crying resulted in breathlessness and cyanosis within approximately 1 minute. We evaluated him as American Society of Anesthesiologists (ASA) physical status 3. Preanesthetic blood tests were difficult to obtain because of his uncooperativeness and needle phobia. Even his pediatrician performed only

with cardiovascular disease appear to be particularly prone to severe arrhythmias as a result of dental stress or vasopressor-containing local anesthesia. 9 Atrioventricular (AV) block is a type of bradyarrhythmia. Common causes of AV block include ischemic heart disease, various drugs (eg, digitalis and calcium channel blockers), connective tissue disorders, and rheumatic fever. 10 , 11 Second-degree atrioventricular (AV) block involves partial interruption of impulse transmission from the atria to the ventricles and is rarely seen during dental

rhythm can occur with some severe systemic diseases (eg, acute myocardial infarction, unstable angina pectoris, sick sinus syndrome, acute rheumatic fever) and the use of some drugs (eg, digitalis intoxication, following long-term verapamil therapy). 9 , 10 Therefore, it is necessary to consider these factors when a junctional rhythm appears, especially if it was not noted preoperatively. Certainly, potent inhalation anesthetics and other anesthetics that suppress sympathetic activity may be causative. In conclusion, we experienced 2 episodes of junctional