Dynamic LVOT

Abstract

Dynamic LVOT obstruction can be seen in many situations; examples include hypertrophic obstructive cardiomyopathy, Takotsubo cardiomyopathy, apical myocardial infarction with hypercontractile basal segments, inotropic therapy, and more. Significant LVOT obstruction may present acutely with shortness of breath and signs of hypoperfusion, mimicking the clinical picture of cardiogenic shock. Making the diagnosis of LVOT obstruction can be critical; therapies that are traditionally used for treating cardiogenic shock (i.e., inotropes, diuretics) can exacerbate and worsen the LVOT obstruction and a vicious cycle can be created. Echocardiography plays a central role in making this diagnosis. Provocation measures should be performed if no resting gradient can be found yet anatomic or clinical considerations suggest a possibility of inducible LVOT obstruction. All available data should be considered—m-mode, 2D imaging, color Doppler, and spectral Doppler. Careful attention to details is critical for demonstrating and grading the severity of LVOT obstruction.