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Unstable angina complicated with dynamic left ventricular outflow tract obstruction
Kazuyuki Ozaki1,2, Takeshi Okubo1,2, Kenichi Hagiya1,3
1Department of Cardiology, Niigata City General Hospital, Japan.
Journal of Cardiology Cases
|April 12, 2021
Summary
Left ventricular outflow tract obstruction (LVOTO) with unstable angina (uAP) requires careful management. Percutaneous coronary intervention (PCI) and beta-blockers effectively treated these complex cases, improving outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Left ventricular outflow tract obstruction (LVOTO) and unstable angina (uAP) present diagnostic challenges due to similar symptoms.
- Nitrate use, common in ischemic heart disease, can exacerbate LVOTO.
Observation:
- Three cases of dynamic LVOTO with sigmoid septum, not typical hypertrophic obstructive cardiomyopathy, complicated by uAP were observed.
- Initial percutaneous coronary intervention (PCI) for left anterior descending artery lesions improved LVOTO in all cases.
- Dobutamine stress testing provoked LVOTO in two patients, but not in one with basal septal myocardial infarction post-PCI.
Findings:
- PCI for coronary artery lesions and subsequent beta-blocker therapy led to favorable clinical courses in all three patients.
- LVOTO was provoked by dobutamine stress testing in two of three patients, indicating dynamic obstruction.
- One patient with acute myocardial infarction of the basal septum did not show provoked LVOTO after PCI.
Implications:
- Revascularization, including PCI, should be prioritized in acute coronary syndrome with LVOTO.
- Combined PCI and beta-blocker therapy offers a successful treatment strategy for LVOTO with uAP.
- Understanding the interplay between coronary artery disease and dynamic LVOTO is crucial for patient management.
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