Document Detail


Dynamic left ventricular outflow tract obstruction in acute coronary syndromes: an important cause of new systolic murmur and cardiogenic shock.
MedLine Citation:
PMID:  10488794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Dynamic left ventricular outflow tract (LVOT) obstruction has traditionally been associated with hypertrophic obstructive cardiomyopathy. Recently, acute dynamic LVOT obstruction has been described as a complication of myocardial infarction (MI). Herein the cases of 3 patients are described, all of whom presented with a systolic murmur and electrocardiographic evidence of MI. All 3 patients developed cardiogenic shock and were subsequently found by echocardiography to manifest an acute dynamic LVOT obstruction. Cardiogenic shock persisted until therapy was directed toward decreasing the degree of the dynamic LVOT obstruction. The treatment of acute coronary syndromes in the presence of a dynamic LVOT obstruction differs from the traditional treatment of acute coronary syndromes and includes the use of beta-blockers and alpha1-agonists, as well as the avoidance of therapies that aggravate the magnitude of the LVOT obstructive gradient, including nitrates, inotropic agents, and afterload reduction. The development of a systolic murmur in the setting of acute MI complicated by cardiogenic shock with only a small elevation in creatine kinase suggests the presence of a dynamic LVOT obstruction, as well as the classical mechanical complications of MI, namely, ventricular septal rupture and papillary muscle rupture. The presence of a dynamic LVOT obstruction is reliably detected by transthoracic echocardiography or by transesophageal echocardiography if transthoracic image quality is suboptimal.
Authors:
J H Haley; L J Sinak; A J Tajik; S R Ommen; J K Oh
Related Documents :
18599494 - Decreasing incidence of critical limb ischemia after intra-aortic balloon pump counterp...
3611494 - Relation of oxygen transport patterns to the pathophysiology and therapy of shock states.
6581394 - Subacute cardiac rupture: a surgical emergency.
16757084 - Cardiogenic shock in a young female with multiple sclerosis.
12546574 - Factors and forces influencing stent-graft migration after endovascular aortic aneurysm...
7219544 - Localization of pacemaking activity in early embryonic heart monitored using voltage-se...
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  74     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-09-23     Completed Date:  1999-09-23     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  901-6     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Creatine Kinase
Diagnosis, Differential
Echocardiography, Doppler
Female
Heart Murmurs / etiology*,  ultrasonography
Humans
Male
Myocardial Infarction / complications*,  ultrasonography
Shock, Cardiogenic / etiology*,  ultrasonography
Systole
Ventricular Outflow Obstruction / complications*,  physiopathology,  therapy,  ultrasonography*
Chemical
Reg. No./Substance:
EC 2.7.3.2/Creatine Kinase
Comments/Corrections
Comment In:
Mayo Clin Proc. 2000 Feb;75(2):216-7   [PMID:  10683665 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Acute aortic insufficiency associated with Wegener granulomatosis.
Next Document:  Acquired binocular horizontal diplopia.