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Pathophysiology of Dynamic Left Ventricular Outflow Tract Obstruction in a Critically Ill Patient
Author(s) -
Caselli Stefano,
Martino Annamaria,
Genuini Igino,
Santini Daria,
Carbone Iacopo,
Agati Luciano,
Fedele Francesco
Publication year - 2010
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/j.1540-8175.2010.01210.x
Subject(s) - medicine , ventricular outflow tract obstruction , intensive care unit , shock (circulatory) , hypovolemia , cardiology , hemodynamics , intensive care , intensive care medicine , discontinuation , mitral valve
Left ventricular outflow tract obstruction is not a rare problem in the intensive care units and can precipitate hemodynamic shock unresponsive to catecholamine therapy. The use of echocardiographic examination is extremely important in recognizing this phenomenon and its underlying conditions, finally identifying the most appropriate therapeutic strategy. The simple correction of one or more of these factors can dramatically change patients clinical outcome. We report the clinical case of a 72‐year‐old man who developed hemodynamic shock in the intensive care unit. Hypovolemia, catecholamine infusion, and mechanical ventilation induced geometric modification of the left ventricle causing a systolic anterior motion of the mitral anterior leaflet and a severe subaortic gradient. Simple restoration of fluids and discontinuation of medical therapy dramatically changed the outcome of the patient. A review of the medical literature has been carried out to deeply investigate pathophysiology of left ventricular outflow tract obstruction in critically ill patients. (Echocardiography 2010;27:E122‐E124)