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Home | CCC | Left Ventricular Outflow Tract Obstruction (LVOTO)

Left Ventricular Outflow Tract Obstruction (LVOTO)

by Dr Chris Nickson, last update March 24, 2019

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)
CCC 700 6

Critical Care

Compendium

…more CCC

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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