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Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient

View Article: PubMed Central - PubMed

ABSTRACT

Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients' symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients.

No MeSH data available.


(a) Long-axis view at rest. (a′) Corresponding left ventricular outflow tract velocity. (b) Long-axis view at 10 Watts. (b′) Corresponding left ventricular outflow tract velocity. (c) Long-axis view at 30 Watts. (c′) Corresponding left ventricular outflow tract velocity. (d) Long-axis view at peak exercise. (d′) Corresponding left ventricular outflow tract velocity.
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fig3: (a) Long-axis view at rest. (a′) Corresponding left ventricular outflow tract velocity. (b) Long-axis view at 10 Watts. (b′) Corresponding left ventricular outflow tract velocity. (c) Long-axis view at 30 Watts. (c′) Corresponding left ventricular outflow tract velocity. (d) Long-axis view at peak exercise. (d′) Corresponding left ventricular outflow tract velocity.

Mentions: Pacemaker implantation was considered due to the previous syncopes and the findings of first degree of AV-block. However, we decided to evaluate the hemodynamics of the patient during a semisupine bicycle exercise-stress test with simultaneous echocardiography. At rest, blood pressure (BP) was 108/68 mmHg and heart rate (HR) was 90 beats/min. At 10 Watts BP was 98/61 mmHg, HR was 94 beats/min, and LVOT velocity was still normal at 1.5 m/s. At 30 Watts BP declined to 88/51 mmHg, HR was 98 beats/min, and LVOT velocity was between 2.0 and 3.5 m/s with a shark fin pattern. At peak exercise (40 Watts), BP was 74/45 mmHg and HR 106 beats/min. Severe SAM was noted at this point and the patients felt dizziness and dyspnea. The LVOT velocity was between 2.5 and 3.6 m/s (Figure 3).


Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient
(a) Long-axis view at rest. (a′) Corresponding left ventricular outflow tract velocity. (b) Long-axis view at 10 Watts. (b′) Corresponding left ventricular outflow tract velocity. (c) Long-axis view at 30 Watts. (c′) Corresponding left ventricular outflow tract velocity. (d) Long-axis view at peak exercise. (d′) Corresponding left ventricular outflow tract velocity.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121456&req=5

fig3: (a) Long-axis view at rest. (a′) Corresponding left ventricular outflow tract velocity. (b) Long-axis view at 10 Watts. (b′) Corresponding left ventricular outflow tract velocity. (c) Long-axis view at 30 Watts. (c′) Corresponding left ventricular outflow tract velocity. (d) Long-axis view at peak exercise. (d′) Corresponding left ventricular outflow tract velocity.
Mentions: Pacemaker implantation was considered due to the previous syncopes and the findings of first degree of AV-block. However, we decided to evaluate the hemodynamics of the patient during a semisupine bicycle exercise-stress test with simultaneous echocardiography. At rest, blood pressure (BP) was 108/68 mmHg and heart rate (HR) was 90 beats/min. At 10 Watts BP was 98/61 mmHg, HR was 94 beats/min, and LVOT velocity was still normal at 1.5 m/s. At 30 Watts BP declined to 88/51 mmHg, HR was 98 beats/min, and LVOT velocity was between 2.0 and 3.5 m/s with a shark fin pattern. At peak exercise (40 Watts), BP was 74/45 mmHg and HR 106 beats/min. Severe SAM was noted at this point and the patients felt dizziness and dyspnea. The LVOT velocity was between 2.5 and 3.6 m/s (Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients' symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients.

No MeSH data available.