title: Left ventricular outflow tract obstruction in ICU patients.
abstract: Left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not unusual in ICU patients particularly with septic shock.
  
  
  
  LVOT was first described in patients with hypertrophic cardiomyopathy and was defined as LV wall thickness at least 15 mm. LVOT is usually because of systolic anterior motion of the mitral valve. By convention, LVOTO is defined as an instantaneous peak Doppler LVOT pressure gradient at least 30 mmHg at rest or during physiological provocation such as Valsalva maneuver. Recently, it has been demonstrated that LVOT can be present in patients with severe hypovolemia or hyperkinesia with or without LV hypertrophy and can lead to hemodynamic compromise. LVOT is because of a combination of precipitating factors, which may or may not be associated with anatomical abnormalities. Decreased preload because of hypovolemia or decreased afterload because of septic shock, increased heart rate, and LV hyperkinesis produced by dobutamine infusion can induce a change of LV shape and induce LVOTO.
  
  
  
  LVOTO is not uncommon in ICU patients and can be observed at the early phase of septic shock. Treatment should include discontinuation of dobutamine infusion and fluid infusion. β blockers can be useful in this clinical situation.
authors.affiliation: aMedical Intensive Care Unit bDepartment of Cardiology, Amiens University Hospital cUnité INSERM 1088, Université Picardie Jules Verne, Amiens, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Julien
authors.initials: J
authors.lastname: Maizel
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D007362:Intensive Care Units; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology