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[Dynamic left intraventricular obstruction in acute myocardial ischemia]
Insights
This case report details a hypertensive patient experiencing acute myocardial ischemia, identified by ST-segment elevation. A transient systolic murmur resolved with ischemia, linked to left ventricular deformation and dynamic intraventricular gradient shown by Doppler echocardiography.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Case Reports
Background:
- Hypertension is a significant risk factor for cardiovascular events.
- Acute myocardial ischemia can manifest with diverse clinical presentations.
- ST-segment elevation myocardial infarction requires prompt diagnosis and management.
Observation:
- A 60-year-old woman with hypertension presented with acute myocardial ischemia and ST-segment elevation.
- A transient systolic murmur was noted during ischemia and resolved upon its cessation.
- Doppler echocardiography revealed an "hour-glass" left ventricular deformation due to regional akinesia.
Findings:
- The left ventricular deformation during ischemia dynamically impeded left ventricular outflow.
- A significant dynamic left intraventricular gradient was identified using Doppler echocardiography.
- This gradient was directly correlated with the akinesia of the anterior and apical segments.
Implications:
- This case highlights a specific echocardiographic finding during acute myocardial ischemia.
- Understanding dynamic intraventricular gradients is crucial for managing ischemic heart disease.
- Doppler echocardiography is valuable in assessing functional cardiac anatomy during ischemic episodes.
Abstract:
A case of a 60-year-old woman suffering from hypertension, who presented an episode of acute myocardial ischemia with an elevation of the ST segment in the anterior ECG lead, is reported. On examination, a transient loud systolic murmur was present; it completely disappeared soon after the cessation of acute myocardial ischemia. Doppler echocardiography was performed a few times, during and after the acute ischemia: it was able to show a sort of "hour-glass" deformation of the left ventricle due to the akinesia of the anterior and apical segments. This functional anatomic deformation hampers the outflow from the left ventricle thus creating a dynamic left intraventricular gradient, which is clearly shown by pulsed wave and continuous Doppler echocardiography.