Cases in Diastology - 45 year old man with DOE
Mario Jorge Garcia, MD, FACC
Director, Echocardiographic Laboratory Cardiovascular Imaging Center
- 45 year old man with Dyspnea on Exertion (DOE)
- Hx: Heart murmur detected at adolescence. Recent DOE.
- PE: BP=130/70, HR 60, RR 14, JVP normal, clear lungs, III/VI late systolic murmur increasing with Valsalva, brisk pulses, no edema.
- ECG: NSR, LVH with strain
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Video 1 - click on the small arrow on the bottom left of the player to start & stop tape
E = 100 cm/s
A = 48 cm/s
E/A = 2.1
DT = 140 ms
Adur = 130 msec
Video 2 - click on the small arrow on the bottom left of the player to start & stop tape
Em(s) = 7.8 cm/s
Em(l) = 10.0 cm/s
Video 3 - click on the small arrow on the bottom left of the player to start & stop tape
Intraoperative TEE
- LV EDV = 75 ml
- LV ESV = 32 ml
E = 104 cm/s
A = 43 cm/s
E/A = 2.4
DT = 140 ms
Adur = 130 msec
S = 93 cm/s
D = 74 cm/s
S/D = 1.3
AR = 46 cm/s
ARdur = 180 msec
Vp = 50 cm/s
Determinants of Diastolic Function
Which of the following is true about LV relaxation?
E = 104 cm/s
A = 43 cm/s
E/A = 2.4
DT = 140 ms
Adur = 130 msec
The mitral inflow pattern in this patient may indicate any of the following, except:
A. Elevated LV filling pressures
B. Normal LV relaxation
C. Decreased LA contractility
D. Reduced LA conduit function
LV Relaxation ?
E = 106 cm/s
A = 43 cm/s
E/A = 2.5
Answer = normal or abnormal due to high preload
Em(s) = 7.8 cm/s
Em(l) = 10.0 cm/s
Answer = abnormal in the septum normal in the lateral wall
Vp = 50 cm/s
Answer = Borderline low
LV stiffness
ARdur-Adur = 45msec
DT = 140 msec
Based on the transmitral and PV pulsed Doppler, the following are true statements, except:
DT = 140 msec
Answer = operating stiffness (dp/dV)
increased (=0.30mmHg/ml)
QAR-QA = 45msec
Answer = end-diastolic stiffness increased
LA function ?
Answer = LA contractility normal
Filling Pressures ?
E = 104 cm/sec
Vp = 50 cm/sec
Answer = Filling pressures elevated
Intracardiac Pressures
- LV Sys = 150 mmHg
- LV (-) dP/dt = 1,380 mmHg/sec
- Tau = 48 msec
- Mean LAP = 19 mmHg
-
- KLV = 0.34 mmHg/ml
- KED = 0.29 mmHg/ml
Moderate diastolic dysfunction
- Borderline relaxation
- Increased LV stiffness
- Normal atrial contractility
- Elevated filling pressures
Answers:
Which of the following is true about LV relaxation?
Return to Question
The mitral inflow pattern in this patient may indicate any of the following, except:
Return to Question
Based on the transmitral and PV pulsed Doppler, the following are true statements, except:
Return to Question
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