Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction.
Hypertrophic obstructive cardiomyopathy with significant hypertrophy of the basal septum is the most frequently reported cause of left ventricular outflow tract (LVOT) obstruction. Additionally, other conditions such as dehydration, sepsis, vasodilatation, or mitral valve repair have been associated with LVOT obstruction. In this report, we present a case of a patient without hypertrophy who developed severe dynamic left ventricular outflow tract obstruction during catecholamine stimulation for shock that complicated severe pancreatitis. The present case serves as a reminder that hypovolemia together with a hyperdynamic state resulting from catecholamine administration may result in the development of dynamic LVOT obstruction even if baseline cardiac evaluation is unremarkable. Early detection and intensive efforts to reverse the underlying conditions, including cessation of catecholamine therapy and correction of hypovolemia are essential.
Auer
J
J
Berent
R
R
Weber
T
T
Lamm
G
G
Eber
B
B
D000208:Acute Disease; D000328:Adult; D002316:Cardiotonic Agents / Q000009:adverse effects*; D004298:Dopamine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000009:adverse effects*; D010195:Pancreatitis / Q000150:complications; D012769:Shock / Q000188:drug therapy / Q000209:etiology; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D014694:Ventricular Outflow Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D004298:Dopamine; D009638:Norepinephrine