- Diastolic dysfunction (DD)
- Diastole is an active process and DD refers to abnormaliites of active myocardial relaxation
- 4 phases of diastole
- Isovolumetric relaxation
- Early rapid filling
- Diastasis
- Low flow in late diastole
- Late rapid filling (artial kick)
- 4 underlying mechanisms, net effect is production of raised LVEDP for any given LVEDV
- Slow/incomplete relaxation
- Impaired peak LV filling rate
- Altered elasticity
- Pericardial constriction
- Pt is commonly asymptommatic, but once symptommatic they show the same as systolic dysfunction
- Dyspnoea
- PND
- Orthopnoea
- Raised JVP
- Displaced apex
- S3/4
- Hepatomegaly
- Cardiomegaly
- Exercise intolerance is an early sign
- Treatment
- Exercise is beneficial
- Treatment of hypertension
- Chronic AF
- Adequate rhythm control
- Tight rate control if can't keep in SR
- Prevention of coronary artery disease
- Nitrates, diuretics
- Use with caution as patients are sensitive to reductions in circulatory volume
- Echo findings
- Transmural flow velocity
- Shows to abnormal E:A wave ratios
- Pulmonary venous flow (PVF)
- PVF reversal becomes more pronounced as LAP rises
- Isovolumetric relaxation time
- Deceleration time
- Relates to rate of dissipation of transmitral pressure gradient and is a function of LV compliance
- Prolongation in early disease, normalises in late disease
- Tissue doppler
- Used to assess myocardial movement around the annulus of the mitral valve (moves away from the apex during diastole, and towards during atrial contraction)
- Cannot increase LVEDV on exertion so tolerate certain stresses poorly
- AF
- Atrial kick becomes more important
- Tachycardia
- Late phase of diastole becomes important
- Hypertension
- Increases LV wall tension
- Ischaemia
- Increases LAP leading to wheeze, SOB & pulmonary oedema
- CEACCP
Link:ceaccp.oxfordjournals.org/content/9/1/29.full.pdf