Recent literature has indicated that dynamic LVOT obstruction can occur in critically ill patients without hypertrophic cardiomyopathy. In fact, a recent study found that this condition may be present in many patients with septic shock.
Risk factors for LVOT obstruction include any condition that decreases afterload, decreases preload, or increases heart rate.
Consider LVOT obstruction when your ultrasound demonstrates close approximation of the lateral wall and septum plus systolic anterior motion of the anterior mitral leaflet.
The treatment of patients with dynamic LVOT obstruction includes:
Increasing preload with aggressive IVFs
Increasing afterload (phenylephrine may be a good choice)
Avoiding inotropes
Decreasing heart rate (often with esmolol)
References
McLean AS. Echocardiology in shock management. Crit Care 2016; 20:275.
Slama M, et al. Left ventricular outflow tract obstruction in ICU patients. Curr Opin Crit Care 2016; 22:260-6.
