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Acute myocardial ischemia associated with latent left ventricular outflow tract obstruction in the absence of left

Steve P Page1, Antonis Pantazis, Perry M Elliott

  • 1Heart Hospital, University College London, London, United Kingdom.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|June 5, 2007
PubMed

Insights

Latent left ventricular outflow tract obstruction (LVOTO) can be missed in patients with acute myocardial ischemia. Exercise echocardiography is crucial for diagnosing LVOTO when resting studies are inconclusive.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Echocardiography

Background:

  • Left ventricular outflow tract obstruction (LVOTO) is commonly associated with hypertrophic cardiomyopathy.
  • LVOTO can also manifest in other conditions, including acute myocardial ischemia.
  • Diagnosis often relies on identifying echocardiographic substrates like ventricular hypertrophy.

Observation:

  • Two cases of latent LVOTO presenting with acute myocardial ischemia were observed.
  • These patients lacked obstructive coronary artery disease.
  • Initial resting echocardiograms did not reveal hypertrophy or other typical LVOTO substrates.

Findings:

  • LVOTO was only evident during provocative exercise stress testing.
  • Delayed diagnosis occurred due to the absence of findings on resting echocardiography.
  • Exercise echocardiography successfully identified the latent LVOTO in both cases.

Implications:

  • Highlights the importance of considering LVOTO in unexplained myocardial ischemia.
  • Underscores the diagnostic utility of exercise echocardiography for latent LVOTO.
  • Suggests that provocative testing may be necessary for accurate diagnosis in select patients.

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