Hypertrophic Obstructive Cardiomyopathy, Yamaguchi Syndrome and Kounis Syndrome: Clinical Challenges

485 The Editor, In the interesting report concerning the case of an apical variant of hypertrophic cardiomyopathy also called as Yamaguchi syndrome published in Annals of Cardiac Anesthesia,[1] the authors stated that anesthetic management of these patients is similar to case of hypertrophic obstructive cardiomyopathy. Therefore, alleviating sympathetic stimulation such as avoiding tachycardia, maintaining normal sinus rhythm and euvolemia, and avoiding any increase in cardiac contractility is helpful. However, serious challenges concerning anaphylaxis, labor, anesthesia, and surgery should be always considered in anesthesia and surgery.