Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction

Auer, Johann; Berent, Robert; Weber, Thomas; Lamm, Gudrun; Eber, Bernd

doi:10.1016/j.ijcard.2004.02.011

Cited by 33 publications

(26 citation statements)

References 8 publications

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“…Rationale: Only a series of three case reports could be found to specifically address this issue. One case reported decompensation of a patient intraoperatively after ephedrine administration, 39 another case described cardiovascular collapse after a dopamine/norepinephrine combination 40 and one case reported successful use of phenylephrine during caesarean section. 41 Physiologically, it would seem reasonable to avoid the afterload reducing effects of inotropes in these fixed cardiac output states.…”

Section: Statement: Epinephrine Increases Metabolic Abnormalities Commentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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Section: Statement: Epinephrine Increases Metabolic Abnormalities Commentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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“…Beta-blockers, calcium antagonists and interventricular septum ablation or myotomy-myectomy can attenuate left ventricular systolic function or increase preload/afterload, increase the diameter of left ventricular chamber, and consequently the gradients of left ventricular outflow decrease [7] . On the contrary, those measures such as positive inotropics, diuretics and vasodilatiors can improve left ventricular systolic function, decrease preload/afterload and increase the gradients of left ventricular outflow [8,9] . Because of insufficient recognization of systolic anterior motion of the anterior mitral leaflet after aortic valve replacement, none of these 48 patients received one-stage operation treatments.…”

Section: Discussionmentioning

confidence: 99%

Mechanism and correlated factors of SAM phenomenon after aortic valve replacement

Wen

Shu

et al. 2007

J. Huazhong Univ. Sc. Technol.

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To investigate the mechanism and correlated factors of systolic anterior motion (SAM) phenomenon after aortic valve replacement, 48 patients with severe aortic valvular stenosis were studied. Tested by echo-Doppler one week after aortic valve replacement, the patients were divided into two groups: SAM group and non-SAM group. The data of the left ventricular end-diastolic diameters, the left ventricular end-systolic diameters, the left ventricular outflow diameters, the thickness of the interventricular septum, the posterior wall of left ventricle, the blood velocities of left ventricular outflow and intra-cavitary gradients were recorded and compared. The results showed that no patients died during or after the operation. The blood velocities of left ventricular outflow was increased significantly in 9 patients (>2.5 m/s), and 6 of them developed SAM phenomenon. There was significant difference in all indexes (P<0.05 or P<0.01) except the posterior wall of left ventricle (P>0.05) between two groups. These indicated that the present of SAM phenomenon after aortic valve replacement may be directly related to the increase of blood velocities of left ventricular outflow and intra-cavitary gradients. It is also suggested that smaller left ventricular diastolic diameters, left ventricular systolic diameters, left ventricular outflow diameters and hypertrophy of interventricular septum may be the anatomy basis of SAM phenomenon.

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“…It hasalso been observed in septic patients with structurally normal hearts who treated with adrenergic agonists as well as in patients with Pheochromocytoma [2]. The common pathophysiologic mechanism in these cases is International Cardiovascular Forum Journal 8 (2016) DOI: 10.17987/icfj.v8i0.166 presumed to be increased contractilityof the base of the heart in the setting of catecholamine excess with or without hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Graves Induced Reversible LVOT Obstruction.

Smyrlis

Yaranov²,

Khan³

et al. 2016

ICFJ

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A 59-year-old male with a past medical history of obesity (BMI=31), controlled hypertension (HTN) and hyperlipidemia (HLD), presented for evaluation of new exertional dyspnea of three weeks duration. He reported difficulty climbing one flight of stairs in his house; six months ago he was able to exercise without limitations. He also complained of palpitations which he described as intermittent, regular and fast"heart pounding" both at rest and with activity. He denied chest pain, dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, edema and syncope. Review of systems was also significant for 29 lbs of unintentional weight loss in the past six months confirmed by office weight record (199to 176lbs), generalized fatigue, mild hand tremor and insomnia. On physical exam his vital signs were within normal limits. He was noted to have mild exophthalmos as well asa new harsh 3/6 systolic murmur best heard at the 2nd right intercostal space. The murmur was intensified by having the patient stand up. His exam was otherwise unremarkable.His HTN and HLP have been managed by a cardiologist for the past decade during which time he has had three echocardiograms, the most recent one six months prior to presentation for evaluation of atypical chest pain and palpitations. Baseline echocardiogram demonstrated upper limits of normal LV wall thickness and mild diastolic dysfunction and no significant valve disease. There was laminar flow across the LVOT. A 12-lead electrocardiogram (ECG) revealed normal sinus rhythm at 96 beats per minute. Exercise stress echocardiogram six months prior for evaluation of atypical chest pain was diagnostic and negative for ischemia. He exercised for 9 minutes and 31 seconds on the standard Bruce protocol.In view of these findings hyperthyroidism was suspected and a thyroid panel and echocardiogram given the new murmur were obtained.Thyroid function testing was consistent with overt hyperthyroidism: TSH <0.01; FT3 14.4 (normal range 2.3-4.2); FT4 3.6 (normal range 0.7-1.5).Thyroid ultrasound was negative for nodules and TSI and TBII antibodies were positive confirming the diagnosis of Graves disease. Echocardiogram demonstrated hyperdynamic left ventricular(LV)function with an EF>75%, normal septal and posterior wall thickness of 1.1cm, systolic anterior motionof the anterior mitral valve leaflet (SAM) andflow acceleration across the LVOT with peak velocity of 2.5m/s and aresting LVOT gradient of 25mmHg. Figures 1,2. He was referred to an endocrinologist and was started on methimazole 10mg tid, metoprolol XL 50 mg daily, which was subsequently uptitrated to 75 mg daily. Within ten weeks his symptoms completely resolved and his systolic murmur was no longer present. Follow up echocardiogram 3 months later revealed normal LV function with stable mild LVH and resolution of SAM and LVOT gradient. Figures 3,4. DiscussionDynamic left ventricular outflow tract (LVOT) obstruction is most commonly seen in hypertrophic cardiomyopathy (HCM).Typically in HOCM, the hypertrophic basal septum and SAMresult in...

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Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction

Cited by 33 publications

References 8 publications

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Mechanism and correlated factors of SAM phenomenon after aortic valve replacement

Graves Induced Reversible LVOT Obstruction.

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