The Internet Book of Critical Care Podcast IBCC Episode 125 - Left Ventricular Outflow Tract Obstruction
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Aug 2, 2022 AI Snips
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Basics of LVOTO Physiology
- Dynamic left ventricular outflow tract obstruction (LVOTO) occurs when blood flow is impeded at the base of the heart, often pulling the mitral valve anteriorly.
- This causes mitral regurgitation and obstructed forward flow, worsening hemodynamics contrary to usual resuscitation expectations.
Bernoulli Effect in LVOTO
- Fast blood flow through the LVOT pulls the anterior mitral valve toward the septum due to Bernoulli effect, causing obstruction.
- This also causes mitral regurgitation and pulmonary edema because the valve opens inappropriately backwards.
Diverse LVOTO Substrates
- LVOTO can occur in many conditions beyond classic hypertrophic obstructive cardiomyopathy (HOCM).
- It arises in hearts with small LV cavities, hyperdynamic function, floppy mitral leaflets, and worsens with inotropes and reduced preload or afterload.