Case ReportAnteroapical Stunning and Left Ventricular Outflow Tract Obstruction
Section snippets
Case 1
A 62-year-old woman with hypertension presented with a 24-hour history of anterior chest and throat discomfort after an argument with her daughter. Findings on physical examination showed tachycardia. An electrocardiogram (ECG) showed diffuse symmetrical T-wave inversion with QT prolongation (QTc, 570 milliseconds). In the ensuing 12 hours, she developed progressive cardiovascular compromise with hypotension and pulmonary edema. A new harsh 3/6 systolic murmur was noted over the apex and left
DISCUSSION
Our 3 female patients had new-onset chest discomfort, hemodynamic instability due to LVOT obstruction (Figure 1, Figure 2), focal wall motion abnormalities, and abnormalities on ECGs (Figure 3) in the absence of epicardial coronary artery disease or HCM. Suppression of ventricular contractility with β-blockers resulted in resolution of the LVOT gradient (Figure 4) and clinical improvement. On follow-up, the wall motion and LV function had normalized.
The scenarios that may conceivably produce
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