Dynamic Left Ventricular Outflow Tract Obstruction in Acute Coronary Syndromes: An Important Cause of New Systolic Murmur and Cardiogenic Shock

摘要: Dynamic left ventricular outflow tract (LVOT) obstruction has traditionally been associated with hypertrophic obstructive cardiomyopathy. Recently, acute dynamic LVOT described as a complication of myocardial infarction (MI). Herein the cases 3 patients are described, all whom presented systolic murmur and electrocardiographic evidence MI. All developed cardiogenic shock were subsequently found by echocardiography to manifest an obstruction. Cardiogenic persisted until therapy was directed toward decreasing degree The treatment coronary syndromes in presence differs from traditional includes use beta-blockers alpha1-agonists, well avoidance therapies that aggravate magnitude gradient, including nitrates, inotropic agents, afterload reduction. development setting MI complicated only small elevation creatine kinase suggests obstruction, classical mechanical complications MI, namely, septal rupture papillary muscle rupture. is reliably detected transthoracic or transesophageal if image quality suboptimal.