Sudden iatrogenic suicidal right ventricle

It is important to obtain a good withdrawal pressure tracing while performing cardiac catheterization in cases with right ventricular outflow tract (RVOT) obstruction to document the site and severity of obstruction. However efforts to manipulate the catheter in the RVOT (either to obtain the gradients or to position the catheter for an outflow angiogram) can sometimes precipitate severe dynamic RVOT obstruction with complete cessation of forward flow leading to life threatening hypotension. The following hemodynamic traces highlight this rare phenomenon which needs to be borne in mind at all times while performing cardiac catheterization in such patients.