Left ventricular outflow tract obstruction in ICU patients
Michel Slama1, Christophe Tribouilloy, Julien Maizel
1aMedical Intensive Care Unit bDepartment of Cardiology, Amiens University Hospital cUnité INSERM 1088, Université Picardie Jules Verne, Amiens, France.
Current Opinion in Critical Care
|April 8, 2016
Summary
Left ventricular outflow tract obstruction (LVOTO) is common in ICU patients with septic shock. Treatment involves fluid resuscitation and beta-blockers, while discontinuing dobutamine infusion can resolve LVOTO.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Hemodynamics
Background:
- Left ventricular outflow tract obstruction (LVOTO) is typically associated with hypertrophic cardiomyopathy.
- Traditionally defined by LV wall thickness ≥15 mm and peak Doppler gradient ≥30 mmHg.
- Recent findings indicate LVOT can occur in sepsis due to hypovolemia or hyperkinesis, leading to hemodynamic compromise.
Purpose of the Study:
- To review the occurrence and management of LVOTO in intensive care unit (ICU) patients, particularly those with septic shock.
- To highlight the evolving understanding of LVOT causes beyond hypertrophic cardiomyopathy.
Main Methods:
- Review of current literature on LVOTO in ICU settings.
- Analysis of factors contributing to LVOTO, including hypovolemia, septic shock, and pharmacologic interventions.
Main Results:
- LVOTO is frequently observed in ICU patients, especially during early septic shock.
- Causes include decreased preload (hypovolemia) and afterload (septic shock), increased heart rate, and LV hyperkinesis (e.g., dobutamine).
- Systolic anterior motion of the mitral valve is a common mechanism.
Conclusions:
- Prompt recognition and management of LVOTO in septic shock are crucial.
- Treatment strategies include fluid resuscitation, discontinuation of inotropic agents like dobutamine, and consideration of beta-blockers.
Related Concept Videos
01:22Mitral Stenosis I: Introduction
1.2K
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
1.2K
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
419
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
419
01:29Cardiomyopathy V: Interprofessional Care
605
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
605
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
3.1K
Oxygen therapy is a pivotal aspect of medical care, particularly for patients with respiratory ailments. Two prominent oxygen-delivering systems include the Venturi mask and the transtracheal oxygen catheter.
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
3.1K