All right, so welcome back to the Internet Book of Critical Care Podcast. I'm here with Adam

Thomas, and we're going to talk about dynamic left ventricular alpha tract obstruction,

or LVOTO. This is my favorite thing to miss, Josh. I have to say, you think about it when

you shouldn't be thinking about it, and then when I should be thinking about it.

So Josh, today we'll talk about the classic form of LVOT obstruction, which is Hocum, but really you can have LVOT obstruction at a subvalvular, a valvular, a valvular, or a supervalvular level.

Today you'll talk to me about physiology, about why

your classic resuscitation ways are going to make this worse. And then of course we'll talk

about workup, recognition, treatment, treatment, and how to move forward in the future when

you know someone has this, but might not be contributing to their current physiology. So Josh, let's get

into it. Tell me why anything that doesn't let blood come out of the heart is a bad idea.

Yeah, so let me break this down. Blood coming out of the heart is good. We need blood to leave the

heart. Got it. Podcasts done. Yeah, no. Seriously, so LVOTO or LVLFletract destruction is basically this phenomenon that occurs

when the base of the heart is kind of crowded.

Oftentimes, patients have like chronic LVH or Hocum, and there's a lot of blood flowing

in a hyperkinetic fashion through the LVFATRACT, and it kind of sucks the mitral valve toward the LVLVLFletract.

And this creates a couple problems.

It causes mitral regurgitation, so blood's going backwards.

And it creates obstruction to forward flow, so blood can't go forwards.

And that is a huge problem because it messes up all of the human dynamics.

All of it.

The pump no worky-y, right? So this is one of those fun cases of pulmonary edema where you go and ask for a beta blocker

or fill them up and we'll get into that later.

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