OVERVIEW
- associated with myocardial hypertrophy and systolic anterior motion of the the mitral vale
- important to recognise as can contribute to a low output state that gets worse with inotropic support
ASSESSMENT
History
- hypertension
- post AVR
- known LVH or HCM
- increasing inotropes
- no tamponade
Examination
- late systolic murmur over the praecordium
Investigations
- ECHO:
- -> small LV cavity
- -> normal systolic function and no RWMA
- -> AVR functioning well
- -> flow acceleration noted in LVOT on colour Doppler
- -> reduced LVOT area during systole
- -> systolic anterior motion of valve leaflets (MR)
- -> high peak gradient across LVOT
MANAGEMENT
- stop adrenaline
- volume load
- beta-blockers to slow heart rate and reduce contractility
- calcium antagonist
- AV sequential pacing
- vasoconstrictor without inotropic effect (ie. phenylephrine/noradrenaline)
- myomectomy or resection of outflow tract
References and Links
- LITFL CCC — Hypertrophic cardiomyopathy
- Scancrit — Systolic anterior motion (SAM)
Critical Care
Compendium
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