Symptomatic Exercise-Induced Left Ventricular Outflow Tract Obstruction without Left Ventricular Hypertrophy

Anomalous Papillary Muscle Insertion Causing Dynamic Left Ventricular Outflow Tract Obstruction without Hypertrophic Obstructive Cardiomyopathy

“…In the current case, the mechanism of SAM is presumably related to abnormal leaflet coaptation from anterior leaflet restraint induced by the APMI. Furthermore, the anterior displacement of this aberrant papillary muscle may align the anterior mitral leaflet directly within the LV ejection pathway, and so both the papillary muscle and anterior mitral leaflet are swept toward the septum, consistent with previous descriptions [16, 18]. …”

“…Increasingly, primary abnormalities of the mitral valve apparatus in HCM, including abnormal leaflet coaptation, leaflet elongation, chordal slack, and papillary muscle displacement, have been recognized as promoting SAM and generating obstruction [14, 15]. Even in the absence of HCM, SAM has still been shown to occur following treadmill exercise or dobutamine stress [16, 17]. In these settings, intrinsic abnormalities of the mitral apparatus were postulated to be sufficient to cause SAM, independent of significant LV septal wall hypertrophy being present.…”

Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

“…12,13 Stepped Treatment After year 2000, all patients were stratified for sudden death risk. 4 Patients who were deemed to be at increased risk for sudden death because of prior sustained ventricular tachycardia or resuscitated ventricular fibrillation, massive thickening ≥30 mm, sudden death in first degree relative, unexplained syncope, or nonsustained ventricular tachycardia in patients aged ≤30 years were counseled about the benefits and risks of the implanted cardioverter defibrillator (ICD) and, given consent, were implanted.…”

Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report

“…In addition, severe mitral regurgitation, which occurs in the condition in which there is no regional wall motion abnormality, is less likely to originate from the stunned myocardium due to coronary spasm. Recent studies reported that symptomatic dynamic LVOT obstruction may occur even in patients without LVH [5,15]. Another study showed that even a small increased pressure gradient defined by a Doppler velocity > 1.5 m/s during dobutamine stress echocardiography is an independent positive predictor of chest pain and syncope [4].…”

“…Recent studies reported that it may occur even in the absence of LVH and cause symptoms such as chest pain, syncope or both [4,5]. …”