title: Exercise-induced left ventricular outflow tract obstruction. A potential cause of symptoms in the elderly.
abstract: We describe a 79-year-old male patient with no significant risk factors for coronary heart disease besides age and gender. He was referred for cardiology consultation because of effort dyspnea. Diagnostic exams including laboratory tests, chest X-ray, ECG and resting echocardiogram showed no abnormalities. He underwent exercise stress echocardiography, which revealed reduced exercise tolerance and a dynamic left ventricular outflow tract obstruction with an intraventricular gradient of over 50 mmHg. No segmental wall motion abnormalities were observed. He was treated with the beta-blocker bisoprolol 5 mg qd, with significant clinical improvement. Two years later exercise stress echocardiography was repeated and better functional capacity was apparent, with no intraventricular gradient during peak exercise. The authors discuss the clinical importance of this unsuspected cause of symptoms in the elderly.
authors.affiliation: Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal. sofia_almeida@netcabo.pt
authors.forename: Sofia
authors.initials: S
authors.lastname: Almeida
authors.forename: Carlos
authors.initials: C
authors.lastname: Cotrim
authors.forename: Luís
authors.initials: L
authors.lastname: Brandão
authors.forename: Rita
authors.initials: R
authors.lastname: Miranda
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Loureiro
authors.forename: Otília
authors.initials: O
authors.lastname: Simões
authors.forename: Luís
authors.initials: L
authors.lastname: Lopes
authors.forename: Manuel
authors.initials: M
authors.lastname: Carrageta
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress; D015444:Exercise; D006801:Humans; D008297:Male; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology