Dynamic LVOT Obstruction

• Recent literature has indicated that dynamic LVOT obstruction can occur in critically ill patients without hypertrophic cardiomyopathy. In fact, a recent study found that this condition may be present in many patients with septic shock.
• Risk factors for  LVOT obstruction include any condition that decreases afterload, decreases preload, or increases heart rate.
• Consider LVOT obstruction when your ultrasound demonstrates close approximation of the lateral wall and septum plus systolic anterior motion of the anterior mitral leaflet.
• The treatment of patients with dynamic LVOT obstruction includes:
  • Increasing preload with aggressive IVFs
  • Increasing afterload (phenylephrine may be a good choice)
  • Avoiding inotropes
  • Decreasing heart rate (often with esmolol)

References

1. McLean AS. Echocardiology in shock management. Crit Care 2016; 20:275.
2. Slama M, et al. Left ventricular outflow tract obstruction in ICU patients. Curr Opin Crit Care 2016; 22:260-6.