Document Detail


Dynamic left ventricular outflow tract obstruction in critically ill patients.
MedLine Citation:
PMID:  16573425     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To review patients managed in an intensive care unit diagnosed with dynamic left ventricular outflow tract obstruction without hypertrophic cardiomyopathy. PATIENTS AND METHODS: Dynamic left ventricular outflow tract obstruction (DLVOTO) is characteristically associated with hypertrophic cardiomyopathy, although it has also been described in patients without this disorder. We reviewed patients managed in two intensive care units over a one year period who were hypotensive and/or resistant to catecholamine infusions. RESULTS: During the one year period nine critically ill patients were found on echocardiography to have DLVOTO. None of the patients had a prior history of hypertrophic cardiomyopathy (HOCM) or echocardiographic evidence of asymmetrical septal hypertrophy and in three patients HOCM was specifically excluded by prior or convalescent echocardiography or by post mortem analysis. We found the risk factors for DLVOTO included left ventricular hypertrophy, hypovolaemia and use of positive inotropic agents. All patients responded to an increase in intravascular volume, reduction in infused inotropic agents with one requiring metaraminol to maintain blood pressure. CONCLUSIONS: Dynamic left ventricular outflow tract obstruction without hypertrophic cardiomyopathy is not an uncommon cause of hypotension resistant to catecholamines in critically ill patients. The diagnosis is important because management which includes fluid loading, vasopressors and reducing catecholamine infusions, differs from the management of other causes of shock.
Authors:
J M Brown; W Murtha; J Fraser; V Khoury
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine     Volume:  4     ISSN:  1441-2772     ISO Abbreviation:  Crit Care Resusc     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2006-03-31     Completed Date:  2006-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100888170     Medline TA:  Crit Care Resusc     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  170-2     Citation Subset:  -    
Affiliation:
Anaesthetic Department, Frenchay Hospital, Bristol, United Kingdom. brownjules@doctors.org.uk
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Comment In:
Crit Care Resusc. 2002 Sep;4(3):161-3   [PMID:  16573422 ]

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