2. Definition
• Diastolic dysfunction is the condition in which the cardiac muscles are
unable to relax/ diastole to fill ventricle to attain a normal end-
diastolic volume without an inappropriate increase in LV end-diastolic
pressure (LVEDP).
5. Anatomical Bases
In 2D
• LV mass and dimensions
• LV hypertrophy is the commonest cause of diastolic dysfunction
Relative wall thickness
• LA volume and LA volume index
6. Grades of LVDD
• Grade I : (a) Impaired relaxation pattern with NORMAL FILLING pattern.
(b) Impaired relaxation pattern with INCREAED FILLING pattern.
• Grade II : PSEUDONARMALIZATION PATTERN
• Grade III : REVERSIBLE RESTRICTIVE PATTERN
• Grade IV : IRREVERSIBLE RESTRICTIVE PATTERN
9. Pulmonary Venous Flow Pattern
S : Systolic velocity
D: Diastolic velocity
AR : Atrial Reversal velocity
10. Tissue Doppler Imaging
Mitral Annular Motion
S : Systolic velocity
E’ : Early diastolic velocity
A’ : Late diastolic velocity
11.
12. CASE STUDY
• An 88-year-old Japanese man presented to our emergency unit in a
comatose condition with a body temperature below the lower limit of
detection (<32°C when measured under the armpit; <34°C when
measured at the tympanic membrane) and no external injures.
• An electrocardiogram performed on admission showed sinus arrest
and junctional rhythm with a heart rate of 40 beats per minute. Osborn
waves were apparent in leads V4 to V6.