Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise

Latent left ventricular outflow tract obstruction induced by abnormal hypertrophic papillary muscle caused myocardial ischemia

“…However, in the absence of hypertrophic cardiomyopathy, LVOT has been reported after valve operation, in states of hypercontractility, and more widely during stress echocardiography with dobutamine [2]. The onset of this phenomenon has also been occasionally described during effort in patients with suggested coronary artery disease [5], although its clinical importance has yet to be established.…”

“…By exerting a negative inotropic effect and reducing left ventricular ejection acceleration rate, outflow tract gradient is lowered. Therefore, negative inotropic therapy may represent an adequate therapeutic approach in selected patients with dynamic LVOT obstruction identified by stress echocardiography [2]. …”

“…LVOT obstruction can be observed in other clinical conditions such as hypertension, where a concentric hypertrophy is common, after acute myocardial infarction, aortic valve replacement for aortic valve stenosis, mitral valve repair, and also in patients with structurally normal heart during the treatment with catecholamines [2].…”

Revelation of an obstructive hypertrophic cardiomyopathy in an elderly patient

“…The phenotypic features of HCM may develop at any age from infancy to adulthood, and are characterized by a great heterogeneity in the extent, magnitude, and distribution of left ventricular hypertrophy [8]. Hypertrophic obstructive cardiomyopathy (HOCM) often leads to heart failure,severe ischemia [9,10], severe symptoms and death [11]. Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract [12][13][14][15], in asymmetric septal hypertrophy, establishes which is the best treatment strategy [16].…”

“…Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract [12][13][14][15], in asymmetric septal hypertrophy, establishes which is the best treatment strategy [16]. In the treatment of HOCM, drug therapy with negatively inotropic drugs [10], percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion [17,18], surgical myectomy and DDD pacemaker therapy [19] are considered the therapeutical options. We present a case of an obstructive hypertrophic cardiomyopathy in an 84-year-old Italian woman with a left ventricular outflow tract (LVOT) peak gradient with the Valsalva maneuver of 188 mm Hg and with a history of first episode of syncope.…”