Download to read offline
Uploaded byManeendra Singarapu
LVOT OBSTRUCTION IN ICU
This document discusses a case of left ventricular outflow tract (LVOT) obstruction in a septic 60-year-old female patient. LVOT obstruction can occur when there is an anatomical substrate like hypertrophic cardiomyopathy combined with physiological stressors like sepsis that decrease preload and increase contractility. The patient's hypotension worsened due to the LVOT obstruction. Echocardiogram is needed to diagnose and treatment involves increasing preload, decreasing contractility, and using beta-blockers and calcium channel blockers. The importance of recognizing LVOT obstruction in sepsis is discussed as well as prospectively studying the gradient and how it relates to treatment response and mortality.
More Related Content
Similar to LVOT OBSTRUCTION IN ICU
LVOT OBSTRUCTION IN ICU
- 1. LVOT OBSTRUCTION INSEPSIS Dr MANEENDRA MD, FNB, EDIC
- 2. CASE VIGNETTE • 60yr/f • DM / HTN / CAD / LVH • Fever 3 days • Burning micturition 2 days, IN ER : • HR : 130 • BP : 80 / 40 • TEMP : 102F • Conscious , oriented • SPO2 : 98% ON RA FLUID RESUSCITATION – 30 ml/kg VASOPRESSORS desaturates and develops crepts WORSENING HYPOTENSION LVOTO
- 3. HCM AND LVOTO Apicalhypertrophy Symmetrical hypertrophy Asymmetrical septal hypertrophy without obstruction Asymmetrical septal hypertrophy with obstruction Inc LV wall thickness at least 15 mm in one/ more LV myocardial segments instantaneous peak Doppler LVOT pressure gradient at least 30 mmHg at rest or during physiological provocation
- 4. PATHOPHYSIOLOGY HCM, hypertension aortic stenosis mitral valvereplacement or repair steep aortic root angle acute cor pulmonale ballooning syndrome (Takotsubo) sigmoid septum Needs two factors : • Anatomical substrate and • Physiological predisposing conditions
- 5. PATHOPHYSIOLOGY Decrease preload Decreaseafterload Increase heart rate Increase contractility Small and hypercontractile LV Needs two factors : • Anatomical substrate • Physiological predisposing conditions
- 6. Stress cardiomyopathy – takatsubocardiomyopathy hypercontractileLV base mid and distal akinesia reduction in LV chamber size bleeding, diuretics, trauma, or inotrope infusion crowding at the LV outflow level results in systolic anterior motion of the mitral apparatus dynamic obstruction Hypotension new prominent systolic ejection murmur in the left third parasternal area
- 7. DIAGNOSIS • new systolicmurmur in the left low sternal border that increases with Valsalva maneuver or postextrasystole • Definitive diagnosis requires performing an echocardiogram as soon as possible
- 8. TREATMENT Increase preload Increaseafterload Decrease heart rate Decrease contractility Stop Diuretics Vasopressors Ionotropic agents Nitrates Start IV fluids B blockers Ca chnl blockers Disopyramide
- 10.
- 11. IMPORTANCE IVO occurrence inseptic shock patients; correlation between the intraventricular gradient and volume status and fluid responsiveness; mortality rate. prospectively analyzed 218 patients ,septic shock admitted to a general ICU over a 28-month
- 12. CASE VIGNETTE • 60yr/f • DM / HTN / CAD / LVH • Fever 3 days • Burning micturition 2 days, IN ER : • HR : 130 • BP : 80 / 40 • TEMP : 102F • Conscious , oriented • SPO2 : 98% ON RA FLUID RESUSCITATION – 30 ml/kg VASOPRESSORS desaturates and develops crepts WORSENING HYPOTENSION LVOTO
- 13. Take home message •Identify existence of a phenomena of LVOT obstruction in ICU • Learn to measure LVOT pressure gradient using doppler • Early adequate fluid resuscitation of all sepsis patients • Use of B blockers once hemodynamics are controlled with vasopressors to reduce the heart rate • Plan a observational study of measuring LVOT pressure gradient in all septic shock patients and see how it progresses with treatment and how it influences mortality
- 14. EYES WILL SEEONLY WHAT THE MIND KNOWS……. THANK YOU……