Diastolic dysfunction differential diagnosis: Difference between revisions

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*Presence of S4 gallop<ref>Francis G.S., Tang W., Walsh R.A. (2011). Chapter 26. Pathophysiology of Heart Failure. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Heart, 13e.</ref>
*Presence of S4 gallop<ref>Francis G.S., Tang W., Walsh R.A. (2011). Chapter 26. Pathophysiology of Heart Failure. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Heart, 13e.</ref>


===Differentiation of [[Restrictive cardiomyopathy]] with Associated [[Diastolic dysfunction]] from [[Constrictive pericarditis]]===
===Differentiation of [[Restrictive cardiomyopathy]] with Associated Diastolic dysfunction from [[Constrictive pericarditis]]===
*Diastolic dysfunction is characterized by a normal [[ejection fraction]], elevated left ventricular filling pressure and presence or absence of [[heart failure]] symptoms. [[Restrictive cardiomyopathy]] is one of the medical conditions that cause [[diastolic dysfunction]] due to impaired myocardial relaxation.
*Diastolic dysfunction is characterized by a normal [[ejection fraction]], elevated left ventricular filling pressure and presence or absence of [[heart failure]] symptoms. [[Restrictive cardiomyopathy]] is one of the medical conditions that cause [[diastolic dysfunction]] due to impaired myocardial relaxation.
*On the other hand, constrictive cardiomyopathy is also characterized by normal [[ejection fraction]], elevated filling pressures and symptoms of heart failure; however, there is no [[diastolic dysfunction]].
*On the other hand, constrictive cardiomyopathy is also characterized by normal [[ejection fraction]], elevated filling pressures and symptoms of heart failure; however, there is no [[diastolic dysfunction]].
*Thus, when normal ejection fraction and elevated filling pressure are present in the context of a patient presenting with [[heart failure]] symptoms, it is important to differentiate diastolic heart failure (that can be caused by [[restrictive cardiomyopathy]]) and [[constrictive pericarditis]] where no [[diastolic dysfunction]] is present. The differentiation between the two medical conditions is crucial because it helps tailor the treatment plan.
*Thus, when normal ejection fraction and elevated filling pressure are present in the context of a patient presenting with [[heart failure]] symptoms, it is important to differentiate diastolic heart failure (that can be caused by [[restrictive cardiomyopathy]]) and [[constrictive pericarditis]] where no [[diastolic dysfunction]] is present. The differentiation between the two medical conditions is crucial because it helps tailor the treatment plan.


====The Diagnostic Parameters that are Similar Between [[Restrictive cardiomyopathy]] (with Associated Diastolic dysfunction) and [[Constrictive pericarditis]]====
====The Diagnostic Parameters that are Similar Between [[Restrictive cardiomyopathy]] with Associated Diastolic dysfunction and [[Constrictive pericarditis]]====
=====Left Ventricular Filling Pressure=====
=====Left Ventricular Filling Pressure=====
*Elevated left ventricular filling pressure in both conditions
*Elevated left ventricular filling pressure in both conditions
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*Elevated E/A ratio and decreased DT (consistent with pseudo-normal or restrictive filling pattern) in both conditions
*Elevated E/A ratio and decreased DT (consistent with pseudo-normal or restrictive filling pattern) in both conditions


====The Diagnostic Parameters used to Distinguish [[Restrictive cardiomyopathy]] (with Associated Diastolic dysfunction) from Constrictive pericarditis====
====The Diagnostic Parameters used to Distinguish [[Restrictive cardiomyopathy]] with Associated Diastolic dysfunction from Constrictive pericarditis====
=====Mitral Inflow Velocity Pattern=====
=====Mitral Inflow Velocity Pattern=====
*Mitral septal annular e'>7cm/s in [[constrictive pericarditis]]
*Mitral septal annular e'>7cm/s in [[constrictive pericarditis]]

Revision as of 15:12, 23 January 2013

Diastolic dysfunction Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby

Overview

Diastolic heart failure is one of the examples of heart failure with preserved ejection fraction. Other causes that cause heart failure and do not affect ejection fraction need to be differentiated from this condition.

Differentiating Diastolic dysfunction from other Diseases

Differentiation of Diastolic dysfunction from Systolic dysfunction

Characteristics of Systolic dysfunction

Characteristics of Diastolic dysfunction

  • Small, thickened, concentrically hypertrophied ventricles
  • Large atria
  • Impaired blood filling during diastole
  • Normal ejection fraction
  • Systemic elevation of the blood pressure
  • Occurs mainly in elderly women
  • Presence of S4 gallop[1]

Differentiation of Restrictive cardiomyopathy with Associated Diastolic dysfunction from Constrictive pericarditis

The Diagnostic Parameters that are Similar Between Restrictive cardiomyopathy with Associated Diastolic dysfunction and Constrictive pericarditis

Left Ventricular Filling Pressure
  • Elevated left ventricular filling pressure in both conditions
Mitral Inflow Velocity Pattern
  • Elevated E/A ratio and decreased DT (consistent with pseudo-normal or restrictive filling pattern) in both conditions

The Diagnostic Parameters used to Distinguish Restrictive cardiomyopathy with Associated Diastolic dysfunction from Constrictive pericarditis

Mitral Inflow Velocity Pattern
Respiratory Variation in Mitral E Velocity
Hepatic Venous Flow
  • Diastolic flow reversal during expiration in constrictive pericarditis
  • Diastolic flow reversal during inspiration in restrictive pericarditis[2]

Differentiation of Diastolic Dysfunction from other Medical Conditions

References

  1. Francis G.S., Tang W., Walsh R.A. (2011). Chapter 26. Pathophysiology of Heart Failure. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Heart, 13e.
  2. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA; et al. (2009). "Recommendations for the evaluation of left ventricular diastolic function by echocardiography". J Am Soc Echocardiogr. 22 (2): 107–33. doi:10.1016/j.echo.2008.11.023. PMID 19187853.


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