Diastolic Dysfunction

Question 1

What are the 5 main parameters and their norms?

Answer 1

1. LA Volume Index ≤ 34 ml/m2
2. Average E/e’ < 14
3. Septal e’ > 7 cm/s
4. Lateral e’ > 10 cm/s
5. TR velocity < 2.8 m/s

Question 2

Why is VALSALVA done in GRADE 2 and WHAT does it show?

Answer 2

• if TDI and other indicators do not unmask grade 2
• it can change the pseudonormal LV inflow pattern to prolonged: E/A ratio reverts backwards from grade 2 to grade 1

Question 3

Why is VALSALVA done in GRADE 3 and WHAT does it show?

Answer 3

• can convert a restrictive LV inflow pattern to a pseudonormal
• E/A ratio reverts from grade 3 to grade 2 “reversible restrictive DD”

if E/A ratio does not convert = worse

Question 4

Draw MITRAL INFLOW for GRADE 1

Answer 4

Question 5

Draw MITRAL INFLOW for GRADE 2

Answer 5

Question 6

Draw MITRAL INFLOW for GRADE 3

Answer 6

Question 7

What OCCURS in GRADE 1?

Answer 7

impaired ventricular relaxation in early diastole

Question 8

What OCCURS in GRADE 2?

Answer 8

caught between impaired relaxation and abnormal compliance, so mitral inflow appears normal

Question 9

What OCCURS in GRADE 3?

Answer 9

• “abnormal ventricular compliance”
• indicates increased LV filling pressure
• as ventricle fills, LVDP rise rapidly due to stiff ventricle with decreased compliance

Question 10

What are the FOUR BASIC MECHANISMS of disease?

Answer 10

1. primary myocardial disease
2. secondary hypertrophy
3. CAD
4. extrinsic constraint