Graves Induced Reversible LVOT Obstruction.

Athanasios Smyrlis, Dmitry Yaranov, Shahzad Khan, Marc Krichavsky, Lawrence Fisher


Left ventricular outflow tract (LVOT) obstruction is most commonly associated with hypertrophic cardiomyopathy (HCM). Dynamic LVOT obstruction has been described in various clinical settings including Takotsubo cardiomyopathy, sepsis, treatment with adrenergic agonists and in the setting of acute anterior wall myocardial infarction. Reversible LVOT obstruction has been reported after treatment of pheochromocytoma. A common denominatorin these cases is increased inotropy of the basal LV segments, secondary to catecholamine excess, resulting in obliteration of the LVOT. We report the case of a 59 year old male with a structurally normal heart who developed symptomatic LVOT obstruction in the setting of Graves disease. His symptoms and LVOT gradient completely resolved once his thyroid function normalized with appropriate treatment. To our knowledge this is the first case report of hyperthyroidism induced reversible LVOT obstruction. 


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