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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
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
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.
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 tractobstructionMore Related Videos
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