Document Detail

Dynamic left ventricular outflow tract obstruction: an unusual mechanism mimicking anterior myocardial infarction with cardiogenic shock.
MedLine Citation:
PMID:  11214704     Owner:  NLM     Status:  MEDLINE    
Cardiogenic shock is a frequent and threatening complication in the course of acute myocardial infarction. Besides the well known causes (left ventricular failure, acquired interventricular defect, papillary muscle rupture, free wall rupture) other less frequent mechanisms recognize a functional substrate. The recognition of such mechanisms makes us to revert to the treatments with completely different prognostic implications. In our Coronary Care Unit we encountered, in a period of 12 months, 4 patients who presented clinical, electrocardiographic and/or echographic signs and symptoms of acute myocardial infarction, with different degrees of heart failure up to cardiogenic shock. Only 1 patient showed a severe stenosis of the left anterior descending coronary artery and a significant creatine kinase reduction. Left ventriculography, performed at admission, was unable to disclose the true mechanism of clinical presentation. Only a thorough echographic examination disclosed the presence of a dynamic left ventricular outflow tract obstruction as the cause of heart failure culminating in cardiogenic shock. Once recognized, pathophysiological treatment (administration of beta-blockers and withdrawal of vasodilators, inotropic drugs and intra-aortic balloon pump) led to a dramatic improvement, with an almost complete left ventricular function recovery. Left ventricular outflow tract obstruction is a mechanism that can lead to severe heart failure as a complication of an acute myocardial infarction. Conversely such a mechanism can be precipitated by other causes (hypotension, hypovolemia, especially in hypertensive patients) and can mimic an acute myocardial infarction. Its incidence is not negligible: in our Coronary Care Unit it accounted for about 15% of all cases of myocardial infarction requiring inotropic support. An accurate echocardiographic examination is mandatory even after coronary angiography, and always permits the physician to select the appropriate therapy.
A Di Chiara; M Werren; L P Badano; P M Fioretti
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  2     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2001-02-14     Completed Date:  2001-06-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  60-7     Citation Subset:  IM    
Department of Cardiology, Hospital S. Maria della Misericordia, Udine, Italy.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Coronary Angiography / methods
Diagnosis, Differential
Middle Aged
Myocardial Infarction / diagnosis*
Shock, Cardiogenic / drug therapy,  etiology*
Treatment Outcome
Ventricular Outflow Obstruction / complications,  diagnosis*,  drug therapy
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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