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Valsalva maneuver, uncontrolled hypertension, asymmetric septal hypertrophy and dynamic outflow obstruction: a case

Ze-Zhou Song1

  • 1Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. zezhou_song@126.com.

Cases Journal
|January 21, 2009
PubMed

Insights

This study highlights a case of dynamic left ventricular outflow tract obstruction in an elderly woman with severe, uncontrolled hypertension. Echocardiography revealed characteristic findings, emphasizing the importance of this diagnostic tool in managing complex cardiovascular conditions.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Diagnostic Imaging

Background:

  • Elderly patient with a 25-year history of severe, uncontrolled hypertension.
  • Presented with chest distress and recurrent syncope.
  • Physical examination revealed a significant systolic murmur, indicative of potential valvular or outflow tract issues.

Purpose of the Study:

  • To evaluate the cause of severe, uncontrolled hypertension and associated symptoms in an elderly female patient.
  • To investigate the presence and characteristics of left ventricular outflow tract obstruction using echocardiography.

Main Methods:

  • Transthoracic echocardiography, including M-mode and dynamic maneuvers (Valsalva).
  • Physical examination with auscultation.
  • Ultrasound and multislice computed tomography to rule out secondary causes of hypertension.

Main Results:

  • Echocardiography demonstrated a hyperdynamic left ventricle with asymmetrical septal hypertrophy.
  • Systolic anterior motion of the mitral valve and midsystolic aortic valve closure were observed.
  • A dynamic left ventricular outflow tract obstruction was confirmed, with a resting gradient of 55 mmHg, increasing to 114 mmHg with Valsalva maneuver.

Conclusions:

  • The findings indicate dynamic left ventricular outflow tract obstruction as a significant contributor to the patient's severe hypertension and symptoms.
  • Echocardiography is crucial for diagnosing dynamic left ventricular outflow tract obstruction, especially in patients with unexplained severe hypertension.
  • Further management strategies should address both the outflow tract obstruction and the underlying hypertension.

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