[Intra-ventricular pressure gradient and systolic anterior movement of the mitral valve associated with administration of dopamine in a 91-year-old patient].
A 91-year-old woman had decreased systemic blood pressure accompanied by dyspnea and general fatigue after resection of a face tumor (Merkel cell carcinoma). Dopamine was administered to elevate systemic blood pressure, but it did not sufficiently restore the hemodynamic status. Left ventricular apical aneurysm was observed on echocardiogram. Furthermore, SAM (systolic anterior movement of the mitral valve) was observed on M-mode echocardiogram and a pressure gradient of 34.6 mmHg in the midventricular position was confirmed by continuous wave Doppler using the Bernoulli equation. After volume overload and discontinuation of dopamine, SAM completely disappeared and midventricular pressure gradient markedly decreased. Her general condition improved. Because of the narrowed outflow tract, hypercontractile state induced by beta adrenergic stimulation seemed to be one of the important factors for the genesis of SAM and pressure gradient.
Okayama
H
H
Second Department of Internal Medicine, Ehime University School of Medicine.
Hamada
M
M
Shigematsu
Y
Y
Abe
M
M
Mukai
M
M
Matsuoka
H
H
Sumimoto
T
T
Hiwada
K
K
Murakami
B
B
D000368:Aged; D000369:Aged, 80 and over; D004298:Dopamine / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006322:Heart Aneurysm / Q000503:physiopathology*; D006801:Humans; D008943:Mitral Valve / Q000187:drug effects / Q000503:physiopathology*; D011312:Pressure; D013599:Systole; D016277:Ventricular Function, Left / Q000187:drug effects
D004298:Dopamine