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Dynamic left ventricular outflow tract obstruction in a patient with acute coronary syndrome and without the apical akinesia: Potential alternative mechanisms causing a dynamic left ventricular outflow tract obstruction other than a compensatory basal hyperkinesis
Author(s) -
Fujiwara Momo,
Kawai Keisuke,
Kanazawa Natsuki,
Noguchi Masamitsu,
Hasokawa Minoru,
Nanahoshi Masakazu,
Kobayashi Seiichi
Publication year - 2021
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14989
Subject(s) - ventricular outflow tract obstruction , cardiology , medicine , hyperkinesis , basal (medicine) , acute coronary syndrome , afterload , myocardial infarction , hyperkinesia , ventricle , insulin , hypertrophic cardiomyopathy
The mechanism for dynamic left ventricular outflow tract obstruction (LVOTO) after acute coronary syndromes (ACS) is thought to be apical infarction with compensatory hyperkinesia of the residual normally perfused basal segments of the myocardium. However, herein, we report a patient with ACS and dynamic LVOTO (peak gradient of 250 mm Hg at rest) that could not be secondary to apical akinesia. We propose a potential alternative mechanism leading to dynamic LVOTO in ACS, namely, the interplay between sigmoid septum, basal hyperkinesis, and outflow tract narrowing induced by afterload reduction due to acute myocardial ischemia itself.