ABSTRACT
Transient hypotension and atrial stunning are known complications of electro-cardioversion for supra-ventricular tachyarrhythmias, however, a clinically significant cardiac failure is extremely rare in this setting. We, herein, present a 77-year-old African American male who underwent electro-cardioversion following an unremarkable transesophageal echocardiogram (TEE) for a symptomatic atrial flutter of a new onset. Immediately post-cardioversion, he suffered severe hypotension with a depressed LV systolic function. IV dobutamine stabilized his blood pressure.
Subject(s)
Atrial Flutter/therapy , Electric Countershock/adverse effects , Shock, Cardiogenic/etiology , Aged , Atrial Flutter/complications , Atrial Flutter/diagnostic imaging , Echocardiography, Transesophageal , Electrocardiography , Humans , Hypotension/etiology , MaleABSTRACT
Cardiac arrhythmias are rarely inducible in patients with hypertrophic cardiomyopathy on provocative manoeuvres to identify latent obstruction. We present a 40-year-old male with history of nonobstructive hypertrophic cardiomyopathy who presented with lightheadedness. Echocardiogram showed severe asymmetric hypertrophy of the left ventricle without left ventricular outflow tract gradient at rest. On Doppler study with Valsalva manoeuvre, he developed symptomatic nonsustained ventricular tachycardia, which was reproduced on repetition. This emphasizes the importance of provocative manoeuvres to unmask potentially significant physiologic manifestations.
