title: Dynamic left ventricular outflow tract obstruction in critically ill patients: role of transesophageal echocardiography in therapeutic decision making.
abstract: A paradoxic hypotensive response to resuscitative treatment may be the first clue to dynamic left ventricular outflow tract obstruction (DLVOTO) in critically ill patients. If unrecognized, routine interventions aimed at improving cardiac performance may actually result in hypotension and low cardiac output, thus putting patients at risk for adverse event. It is imperative, therefore, that the pathophysiologic processes involved in DLVOTO be fully understood in order to initiate safe and appropriate therapy in critically ill patients. Our presentation and discussion focus on a hypotensive critically ill patient with unrecognized DLVOTO until further evaluation with transesophageal echocardiogram (TEE). We recommend that early TEE be performed on critically ill patients with unexplained hypotension that is poorly responsive to conventional resuscitative measures.
authors.affiliation: Department of Medicine, University of Tennessee, Memphis 38163, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Madu
authors.forename: R
authors.initials: R
authors.lastname: Brown
authors.forename: S A
authors.initials: SA
authors.lastname: Geraci
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003657:Decision Making; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008297:Male; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D014951:Wounds, Stab / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D000316:Adrenergic alpha-Agonists; D002121:Calcium Channel Blockers