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Case report
Norepinephrine-associated left ventricular outflow tract obstruction and systolic anterior movement
  1. Warner Mbuila Mampuya,
  2. Jonathan Dumont and
  3. Francois Lamontagne
  1. Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  1. Correspondence to Dr Francois Lamontagne; francois.lamontagne{at}


In the perioperative setting, norepinephrine is used to increase blood pressure, an effect mediated mostly via arterial and venous vasoconstriction. Thus, norepinephrine is, allegedly, less likely to cause or worsen left ventricular outflow tract obstruction (LVOTO) than other inotropes. We report a case of norepinephrine-associated dynamic LVOTO and systolic anterior movement in a predisposed patient. This report highlights that unrecognised dynamic LVOTO may worsen shock parameters in patients treated with norepinephrine who have underlying myocardial hypertrophy.

  • cardiovascular system
  • contraindications and precautions
  • drug therapy related to surgery
  • adult intensive care
  • unwanted effects / adverse reactions

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  • Contributors JD has significantly participated in the writing of the paper. WMM and FL have both critically reviewed and edited the manuscript and were involved in the clinical management of this case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.