Dynamic left ventricular outflow tract obstruction without basal septal hypertrophy, caused by catecholamine therapy and volume depletion

Abstract

Hypertrophic cardiomyopathy (HCM) with hypertrophy of the basal septum is the most common etiology of left ventricular outflow tract (LVOT) obstruction.In this article, we report the case of a patient with a structurally normal heart who developed hemodynamic deterioration due to severe LVOT obstruction following treatment with catecholamines. Hypovolemia accompanied with a hyperdynamic condition, resulting from catecholamine treatment, may cause dynamic LVOT obstruction due to the systolic anterior motion of the mitral valve leaflet. The solution for this is early recognition and correction of aggravating factors such as, withdrawal of catecholamine therapy and volume replacement.

Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients

“…The results of this study corroborate the association between hypovolemia and the presence of an intraventricular gradient (LVOT or mid-ventricular) in septic patients, as previously described in the literature in the setting of other hypovolemic states, such as acute blood loss [ 5 , 9 ].…”

Left ventricular outflow tract obstruction in ICU patients

“…Normal-indexed left atrium volume is less than 22 AE 6 ml/m 2 [13]. Left atrium volume is an independent indicator of long-term functional capacity and a left atrium volume index more than 34 ml/m 2 has been shown to be predictive of more severe diastolic dysfunction, and adverse cardiovascular outcomes [14].…”

“…Dynamic LVOTO can occur following aortic valve replacement for aortic stenosis [14]. LV hypertrophy combined with immediate postcardiac surgical conditions, such as hypovolemia, blood loss, or dobutamine infusion are contributing factors for the LVOTO.…”

Norepinephrine-associated left ventricular outflow tract obstruction and systolic anterior movement

“…Dynamic LVOTO has been described in the context of congenital hypertrophic cardiomyopathy, acute myocardial infarction with apical–septal akinesia, reduction of the angle between the mitral and aortic valves following mitral or aortic valve surgery, and uncontrolled adrenergic stimulation which may be observed with pheochromocytoma, and dobutamine stress echocardiogram 7. In contrast to dopamine and dobutamine,8 norepinephrine is not recognised as a potential precipitating factor for dynamic LVOTO.…”