Key result
Discontinuation of diuretics and administration of fluids and beta-blockers effectively resolved orthostatic hypotension associated with standing mid-left ventricular obstruction in an 88-year-old woman.
Why the study?
Orthostatic hypotension is typically linked to autonomic dysfunction, but various other mechanisms can also contribute to its occurrence.
Case Report (n=1)
This case highlights that mid-left ventricular obstruction can cause orthostatic hypotension in elderly patients, which can be effectively managed by avoiding volume depletion and using non-vasodilating beta-blockers.
Hypothesis-generating for a treatable upright mid-cavity mechanism of OH; leaves open standing echo and targeted therapy in unexplained LVH syncope.
Background: Orthostatic hypotension (OH) is a common cardiovascular disorder typically associated with autonomic dysfunction. However, various other mechanisms can contribute to its occurrence. Case summary: An 88-year-old woman was referred to the cardiology unit due to recurrent syncope episodes while standing. Echocardiography revealed a normally contracting left ventricle with severe hypertrophy, a restrictive filling pattern, reduced stroke volume, and a decreased inferior vena cava diameter (4 mm/m²). In the standing position, she experienced syncope, and invasive blood pressure monitoring confirmed OH, alongside a normal increase in heart rate and evidence of mid-left ventricular obstruction (MVO) on echocardiogram. Discontinuation of diuretics and administration of fluids and beta-blockers effectively resolved the OH. Discussion: This case underscores the importance of considering mechanisms beyond autonomic dysfunction and volume depletion in the aetiology of OH in elderly patients. Notably, this is the first documented case of OH associated with MVO occurring in an upright posture, resulting in a significant decrease in cardiac output and subsequent syncope. Preventing volume depletion and using non-vasodilating beta-blockers may represent optimal therapeutic strategies in such cases.
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Ordine et al. (2024) conducted a case report in Orthostatic hypotension due to standing mid-left ventricular obstruction (n=1). Discontinuation of diuretics and administration of fluids and beta-blockers was evaluated on Resolution of orthostatic hypotension. Discontinuation of diuretics and administration of fluids and beta-blockers effectively resolved orthostatic hypotension associated with standing mid-left ventricular obstruction in an 88-year-old woman.
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