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Hypertensive hypertrophic obstructive cardiomyopathy crisis resolved with transvenous pacing guided by bedside

Jeffrey F Spindel1, Mohammad Mathbout2, Shahab Ghafghazi2

  • 1Department of Internal Medicine, University of Louisville, Louisville, KY, USA.

Echocardiography (Mount Kisco, N.Y.)
|January 25, 2021
PubMed

Insights

Cardiogenic shock in hypertensive hypertrophic obstructive cardiomyopathy (HHoCM) is challenging. Transvenous pacing optimized hemodynamics in an elderly woman with HHoCM and severe mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine

Background:

  • Cardiogenic shock from hypertrophic obstructive cardiomyopathy (HoCM) poses treatment challenges.
  • Pharmacologic agents can worsen hemodynamics or left ventricular outflow tract (LVOT) obstruction.
  • Hypertensive hypertrophic obstructive cardiomyopathy (HHoCM) in elderly women can mimic HoCM crisis.

Observation:

  • An 81-year-old female patient presented with cardiogenic shock.
  • The patient had hypertensive hypertrophic obstructive cardiomyopathy (HHoCM) with severe mitral regurgitation.
  • Hemodynamic instability was the primary clinical concern.

Findings:

  • Transvenous pacing was employed as a therapeutic strategy.
  • Bedside echocardiography guided pacing to optimize heart rate and LV filling.
  • This approach successfully restored hemodynamic stability.

Implications:

  • Transvenous pacing offers a potential alternative for managing cardiogenic shock in HHoCM.
  • Optimizing rate and LV filling time is crucial for hemodynamic support.
  • This case highlights a novel approach for a complex cardiovascular condition.

Keywords:
cardiomyopathy hypertrophicelderlyhypertrophic cardiomyopathyleft ventricular outflow obstructionmitral regurgitationtransthoracic echocardiography

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