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A3

The correct answer is E, IV fluid bolus. The M-mode reveals severe systolic anterior motion of the mitral valve causing LV outflow tract obstruction. This is not a primary hypertrophic cardiomyopathy per se, but is a common scenario in patients post-op from cardiac surgery who have some degree of LVH and hyperdynamic LV function on inotropes post-op. IV fluids will increase LV preload, increase LV cavity size and decrease the degree of obstruction. IV dobutamine would make the situation worse by increasing LV contractility and lowering systemic afterload. Similarly, IV diuretics would worsen preload and could increase the degree of obstruction. There is no indication from the M-mode of a significant pericardial effusion such that a transesophageal echocardiogram or return to the OR is warranted.

Category:

Valve disease

Author: Atif Qasim, MD FASE
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