Dynamic intraventricular obstruction in acute myocardial infarction

Transient left ventricular dynamic obstruction (TLVO) is an infrequent complication in acute myocardial infarction (AMI). Its hallmark is a new systolic murmur associated with hemodynamic worsening. An echocardiogram is necessary for diagnosis. We report on two cases, both of which had a good outcome. Serial echocardiograms showed that enhanced contractility of the basal left ventricular segments obstructed cardiac ejection by means of mitral value systolic anterior movement in the left ventricular outflow tract. In both cases, the intraventricular gradient remained for several days and subsequently disappeared. The understanding of this mechanism is useful for management of this clinical problem.