DIASTOLIC DYSFUNCTION – ANOTHER WAY TO SEE THINGS! Continuation 3rd post
FERNANDO MORCERF
MD Cardiologist | Professor of Echocardiography | Presential and online Echocardiography courses, ECOR.
Once we all agree with the necessary basic tenets (posted before, if you had not read yet do it now; it′s down below) let′s see how the M mode can show easily if the relaxation of LV is normal (left side of the figure). If the LV normally fills 70% of its final diastolic volume during the initial 1/3 of diastole and only 30% during the final 2/3, it is obvious that the LA empties much more during the initial 1/3 period. That can be seen in a M-mode showing the aorta and the LA. Notice how the posterior aortic wall moves back intensely right after aortic valve closure with a great decrease in LA size and then more slowly during the remaining of diastole and shows a small back displacement with the atrial contraction. This is an important sign of normal LV relaxation. It is a good sign as long you keep the two aortic walls pretty much parallel.
If the relaxation is slow and abnormal (right side of the figure), only 30% of the final LV diastolic volume will leave the LA to enter the LV during the initial 1/3 period of diastole. The final 70% occurs during the last 2/3 and the M-mode will show a mild back movement of the aorta right after aortic valve closure and small decrease in the LA size. The decrease in LA size (and the final return of the aorta) is seen mostly during the final 2/3, mainly during atrial contraction. This is the first and easy sign of abnormal relaxation. Two more signs to come.
Consultant Cardiologist, Teaching Hospital Batticaloa
9 年Thank you very much for sharing this point !
Medico cardiologo en Universidad de los Andes
9 年Very nice point of view that you Said thank you for you expertice
Membro do Conselho Editorial dos Arquivos Brasileiros de Cardiologia
9 年Muito bom Dr. Morcef. Revis?o objetiva e prática. ótimo!
Consultant Critical Care and Anaesthesia Rotherham Hospital NHS foundation trust UK FFICM/ FRCA/MRCP/MD Critical Care Medicine.
9 年Excellent review dear dr.Morcerf...please keep giving these useful and helpful posts. ..
I am a contributor to Bizcatalyst 360. I am a pediatric and adult echocardiographer.
9 年Thanks Fernando for continuing this vital series on diastolic dysfunction.