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Dynamic left ventricular outflow obstruction is associated with structural findings of asymmetric septal hypertrophy (less commonly concentric left ventricular hypertrophy) and systolic anterior motion of the anterior mitral valve leaflet. A patient who did not have this usual substrate for outflow obstruction presented with an acute anterior wall myocardial infarction complicated by congestive heart failure and cardiogenic shock. When an intra-aortic balloon pump was placed, the patient rapidly deteriorated and a dynamic outflow gradient was detected.
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