CHF

Left Ventricular Outflow Obstruction

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Left Ventricular Outflow Obstruction, LVOTO

  • See Also
  1. Cardiogenic Shock
  • Pathophysiology
  1. Occurs with conditions that impair left ventricular filling
  • Causes
  1. Hypertrophic Cardiomyopathy
    1. Abnormally thickened Myocardium and abnormal mitral valve movement impair filling
  2. Subaortic Stenosis
  3. Bicuspid Aortic Valve stenosis
  4. Supravalvular Aortic Stenosis (SVAS)
    1. Rare condition, associated with Williams Syndrome (most common), as well as Familial Hypercholesterolemia
  5. Aortic Coarctation
  6. Hyperdynamic left ventricle
  7. Systolic anterior motion of the mitral valve (SAM)
    1. May complicate Mitral valve regurgitation or Mitral Valve Prolapse
    2. Mitral valve lodges in the left ventricular outflow tract resulting in mechanical obstruction
  • Findings
  1. Cardiogenic Shock
  2. Syncope or Near Syncope
  3. Hypotension
  • Differential Diagnosis
  1. See Cardiogenic Shock
  • Imaging
  1. Echocardiogram
  • Management
  • Acute Emergent
  1. Early, emergent cardiology Consultation
  2. Stabilize Hypotension
    1. Intravenous Fluids (expand left ventricle and slows Heart Rate)
    2. Vasopressors
      1. Peripheral Vasoconstrictors (e.g. Vasopressin) are preferred
      2. Avoid inotropes (increase Heart Rate and contractility) that worsen obstruction
  3. Manage Tachydysrhythmias
    1. Synchronized Cardioversion for Atrial Fibrillation with Rapid Ventricular Rate
  4. Other measures
    1. Avoid initial diuresis (decreases Preload)
  • Resources
  1. Left Ventricular Outflow Obstruction (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK470446/
  • References
  1. DeMeester and Swaminathan (2024) EM:Rap, 9/2/2024