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Hypertrophic obstructive cardiomyopathy with significant hypertrophy of the basal septum is the most frequently reported cause of left ventricular outflow tract obstruction (LVOTO) in the mechanism of systolic anterior movement (SAM). Additionally, other conditions such as dehydration, vasodilatation, mitral valve repair, dobutamine stress echocardiography and pheochromocytoma have been associated with LVOTO. In this report, we present a case of a patient without hypertrophic cardiomyopathy who developed severe LVOTO in the SAM mechanism. The presented case serves as a reminder that hypovolaemia together with hyperdynamic state resulting from increased catecholemines may result in the development of dynamic LVOTO.

Intradialytic hypotension is a frequent complication of hemodialysis. Its etiology is complicated and unclear. Preventive and therapeutic procedures include modification of lifestyle as well as parameters of hemodialysis procedure. Due to multifactorial etiology of this complication we should pay attention to proper prophylactic and in the case of its appearance to adjust the treatment to the individual patient.