Yonsei Med J.  2013 Jul;54(4):1058-1061. 10.3349/ymj.2013.54.4.1058.

Paradoxical Heart Failure Precipitated by Profound Dehydration: Intraventricular Dynamic Obstruction and Significant Mitral Regurgitation in a Volume-Depleted Heart

• Kim D
• Mun JB
• Kim EY
• Moon J

• KMID: 2158246
• DOI: http://doi.org/10.3349/ymj.2013.54.4.1058

Abstract

Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart.

Keyword

Dynamic obstruction; mitral regurgitation; shock; dehydration; echocardiography

MeSH Terms

Cardiac Volume
Dehydration/*complications
Echocardiography/methods
Female
Heart Failure/*etiology/therapy
Humans
Middle Aged
Mitral Valve Insufficiency/complications/*etiology
Pulmonary Edema/etiology
Ventricular Outflow Obstruction/*complications/etiology

Figure

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  Fig. 1 (A) Chest radiograph taken previously. (B) Chest radiograph showing newly developed pulmonary congestion (arrow heads) and fluid collection in the fissure (arrow) at the time of presentation.

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  Fig. 2 (A) Two-dimensional transthoracic echocardiography shows systolic anterior motion of the mitral leaflets (arrow) with left ventricular outflow tract obstruction. (B) Color Doppler image reveals flow acceleration at the left ventricular outflow tract (white arrow) and significant mitral regurgitation (yellow arrow). (C) M-mode image shows systolic anterior motion of the mitral valve leaflets (arrow). (D) M-mode image at the midventricular cavity shows small left ventricular cavity and normal wall thickness.

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  Fig. 3 (A) Two-dimensional transthoracic echocardiography reveals disappearance of systolic anterior motion of mitral leaflets (arrow) after the patient's condition had been stabilized. (B) Color flow image shows resolution of flow acceleration and normal lamina flow at the left ventricular outflow tract. Concurrently, this color flow image after volume restoration therapy shows that previously observed mitral regurgitation has been completely abolished. LA, left atrium; LV, left ventricle; Ao, ascending aorta.

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