Introduction: Apical Hypertrophic Cardiomyopathy (AHCM) is a rare form of Hypertrophic Cardiomyopathy (HCM) which inherits in autosomal dominant pattern affects 1:500 individual, is localized to left ventricular apex with or without formation of apical aneurysm. Although patients are asymptomatic in resting conditions, anesthesia and surgical stress may lead to exacerbation of the left ventricular outflow tract obstruction (LVOT) obstruction and may complicate perioperative course. Case Report: A 65 years old female patient diagnosed with Apical hypertrophic cardiomyopathy presented with primary peritonitis posted for emergency exploratory laparotomy and proceed on Tab Verapamil 160 mg twice daily. We managed this case successfully considering understanding of pathophysiology, hemodynamic changes and anesthetic implications needed for successful perioperative outcome. Conclusion: Patients with apical hypertrophic cardiomyopathy undergoing noncardiac surgery require thorough understanding of hemodynamic changes, proper intraoperative vigilance, avoiding factors that may increase left ventricular outflow tract obstruction with proper medication and intravenous fluid therapy.