emDOCs.net Emergency Medicine (EM) Podcast Episode 119: Left Ventricular Outflow Tract Obstruction (LVOTO)
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May 6, 2025 Dive into the complexities of left ventricular outflow tract obstruction (LVOTO) and its rising occurrence in emergency medicine. Learn how a clinical case of a 43-year-old male with septic shock highlights diagnostic challenges. Discover the importance of echocardiography in identifying LVOTO, including assessing left ventricular hypertrophy and pressure gradients. The discussion also covers effective management strategies that focus on medication adjustments and hemodynamic support for critically ill patients.
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Classic ED LVOTO Case
- A 43-year-old man with mitral valve replacement develops LVOTO during septic shock in the ED while waiting for ICU.
LVOTO Pathophysiology Explained
- LVOTO results from systolic anterior motion of the mitral valve causing obstruction and mitral regurgitation.
Triggers of LVOTO Explained
- LVOTO is often occult until triggered by hypercontractility, tachycardia, or reduced preload from illness or meds.