about 60 y old patient was admitted to our icu with typical clinical afflictions of ACS. Condition after transaortale septal myectomy in the case of HOCM for years. Actually we saw a distinct LV-hypertrophy with midventricular gradient dependent on heart rate. In LVOT we could found a notable acceleration of flow but NO SAM or midsystolic closure of aortic valve. Under the therapy with volume and beta-blocker (esmolol) we could see a rapidly haemodynamic improvement.
DON´T give that patient inotropics in cases of haemodynamic instability!
What do you think about? Make it sense to implantate a DDD-pacemaker to reach an asynchronous stimulation of the heart (with asynchronous contraction behavour/ cycle of right and left ventricle) to moderate the ventricular gradients?