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Updated: Aug 10, 2025

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Dynamic Left Ventricular Outflow Tract Obstruction Exacerbated by Thoracic Kyphosis.

Mohamad S Alabdaljabar1, Mackram F Eleid2

  • 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

JACC. Case Reports
|February 13, 2023
PubMed
Summary

A 74-year-old woman experienced syncope due to dynamic left ventricular outflow tract obstruction (DLVOTO) triggered by kyphosis. Metoprolol treatment showed positive results, highlighting DLVOTO

Keywords:
CBC, complete blood countDLVOTO, dynamic left ventricular outflow tract obstructionIVC, inferior vena cavaLVOTO, left ventricular outflow tract obstructionPVC, premature ventricular contractionRUQ, right upper quadrantTTE, transthoracic echocardiogramdynamickyphosisleft ventricular outflow tractobstruction

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Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • Dynamic left ventricular outflow tract obstruction (DLVOTO) can be difficult to diagnose without resting obstruction.
  • Kyphosis is a spinal condition that can affect cardiovascular function.

Observation:

  • A 74-year-old woman presented with kyphosis and symptoms of pre/syncope.
  • Heart catheterization revealed DLVOTO exclusively in the kyphotic posture, demonstrating the Brockenbrough-Braunwald response.
  • The patient responded positively to metoprolol treatment.

Findings:

  • Positional dynamic left ventricular outflow tract obstruction (DLVOTO) can cause syncope.
  • The Brockenbrough-Braunwald response is a key indicator of DLVOTO in specific postures.
  • Pharmacological management with metoprolol can be effective for DLVOTO.

Implications:

  • This case highlights the importance of considering positional maneuvers in diagnosing DLVOTO.
  • Early diagnosis and management of DLVOTO can prevent adverse cardiovascular events.
  • Metoprolol may be a viable treatment option for patients with positional DLVOTO.