Diastolic dysfunction differential diagnosis
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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
- Large, dilated, eccentrically hypertrophied ventricles
- Impaired blood ejection during systole
- Decreased cardiac output and ejection fraction
- Normal or decreased blood pressure
- Can occur in any age and more frequent in men than in women
- Presence of S3 gallop
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
- 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.
- 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
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
- Mitral septal annular e'>7cm/s in constrictive pericarditis
- Mitral septal annular e'<7 cm/s in restrictive cardiomyopathy
Respiratory Variation in Mitral E Velocity
- An increase of more than 25% with expiration is noted in constrictive pericarditis
- Absent in restrictive cardiomyopathy
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
- Right heart failure
- Valvular heart disease
- Pericardial diseases - constrictive pericarditis, cardiac tamponade
- Cardiac tumors
- High output cardiac failure
References
- ↑ 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.
- ↑ 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.