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Dynamic LVOT Obstruction
- Recent literature has indicated that dynamic LVOT obstruction can occur in critically ill patients without hypertrophic cardiomyopathy. In fact, a recent study found that this condition may be present in many patients with septic shock.
- Risk factors for LVOT obstruction include any condition that decreases afterload, decreases preload, or increases heart rate.
- Consider LVOT obstruction when your ultrasound demonstrates close approximation of the lateral wall and septum plus systolic anterior motion of the anterior mitral leaflet.
- The treatment of patients with dynamic LVOT obstruction includes:
- Increasing preload with aggressive IVFs
- Increasing afterload (phenylephrine may be a good choice)
- Avoiding inotropes
- Decreasing heart rate (often with esmolol)
References
- McLean AS. Echocardiology in shock management. Crit Care 2016; 20:275.
- Slama M, et al. Left ventricular outflow tract obstruction in ICU patients. Curr Opin Crit Care 2016; 22:260-6.