Key result
Cessation of epinephrine infusion and intravascular volume expansion rapidly resolved severe left ventricular outflow tract obstruction in a patient with anaphylactic shock.
Case Report (n=1)
Transoesophageal echocardiography is crucial in epinephrine non-responsive anaphylactic shock to identify SAM/LVOTO, which requires cessation of epinephrine and volume expansion.
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Supports TEE in anaphylaxis resuscitation; hypothesis-generating for epinephrine-related LVOTO without risk factors.
We describe a case of severe left ventricular outflow tract obstruction (LVOTO) with severe mitral incompetence due to systolic anterior motion of the anterior mitral leaflet (SAM) that was recognised thanks to the immediate availability of transoesophageal echocardiography during the resuscitation of anaphylactic shock. The patient rapidly responded to cessation of the epinephrine (adrenaline) infusion and intravascular volume expansion with intravenous crystalloid. The absence of risk factors for developing SAM/LVOTO serve as a warning to clinicians to consider this diagnosis in all cases of epinephrine non-responsive anaphylactic shock.
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Sadleir et al. (2018) conducted a case report in Intraoperative anaphylactic shock complicated by SAM/LVOTO (n=1). Cessation of epinephrine infusion and intravascular volume expansion was evaluated on Clinical response. Cessation of epinephrine infusion and intravascular volume expansion rapidly resolved severe left ventricular outflow tract obstruction in a patient with anaphylactic shock.
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