# Transient systolic anterior motion in a patient with junctional rhythm in the intensive care unit

## TL;DR

A patient in the ICU showed temporary mitral valve movement due to a heart rhythm issue and medication, which improved when the heart rhythm was adjusted.

## Contribution

This case highlights transient systolic anterior motion caused by junctional rhythm and medication in ICU patients.

## Key findings

- Transient systolic anterior motion was observed in a patient with junctional rhythm.
- High doses of dobutamine and nitroglycerin contributed to the SAM phenomenon.
- TEE showed improvement in SAM when transitioning to a ventricular paced rhythm.

## Abstract

Systolic anterior motion (SAM) of the mitral valve refers to the unusual movement of the anterior and sometimes the posterior mitral valve leaflets toward the left ventricular outflow tract (LVOT) during systole. This phenomenon is most frequently associated with the asymmetric septal variant of hypertrophic cardiomyopathy (HCM), but it can also occur in conditions like acute myocardial infarction, diabetes mellitus, hypertensive heart disease, after mitral valve repair, and even in asymptomatic individuals during dobutamine stress tests. We present a case of transient SAM induced by a junctional rhythm along with high doses of dobutamine and nitroglycerin in an intensive care unit (ICU) setting. Transesophageal echocardiography (TEE) played a crucial role in detecting SAM and showed that transitioning from a junctional rhythm to a ventricular paced rhythm led to an improvement in the SAM condition.