Title: Dynamic LVOT Obstruction<br/>Author: Mike Winters<br/><a href='http://umem.org/profiles/faculty/141/'>[Click to email author]</a><hr/><p>
        <strong><u>Dynamic LVOT Obstruction</u></strong></p>
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                Recent literature has indicated that dynamic LVOT obstruction can occur in critically ill patients <em>without</em> hypertrophic cardiomyopathy. In fact, a recent study found that this condition may be present in many patients with septic shock.</li>
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                Risk factors for  LVOT obstruction include any condition that decreases afterload, decreases preload, or increases heart rate.</li>
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                Consider LVOT obstruction when your ultrasound demonstrates <u>close approximation of the lateral wall and septum</u> plus <u>systolic anterior motion of the anterior mitral leaflet</u>.</li>
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                The treatment of patients with dynamic LVOT obstruction includes:
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                                Increasing preload with aggressive IVFs</li>
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                                Increasing afterload (phenylephrine may be a good choice)</li>
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                                Avoiding inotropes</li>
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                                Decreasing heart rate (often with esmolol)</li>
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<fieldset><legend>References</legend>

                <ol>
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                McLean AS. Echocardiology in shock management. <em>Crit Care</em> 2016; 20:275.</li>
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                Slama M, et al. Left ventricular outflow tract obstruction in ICU patients. <em>Curr Opin Crit Care</em> 2016; 22:260-6.</li>
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