Diastolic Dysfunction

by Carlo Raj, MD

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    00:00 Let us take a look at diastolic dysfunction. Now there is a lot there with systolic dysfunction.

    00:04 We did a lot of integration. It is imperative that you know all of this. Spend a little bit of time with what I have told you. Review how to integrate everything and you will be in great shape. It can’t shake you ever. So with diastolic dysfunction, what is going on here? It is the fact the left ventricle is becoming thickened, why? Well, maybe there is increased pressure. Why? Maybe there is hypertension, either primary or secondary, usually it is primary, much more common, 95 percent of the time. And maybe aortic stenosis. And now at this point, the left ventricle is undergoing what is known as concentric hypertrophy, and so therefore cannot properly fill up the left ventricle. We have diastolic dysfunction. And could you have preservation of your ejection fraction? Sure you can. Diastolic dysfunction well. We have more and more understanding and hence why it's so important for you to make sure you distinguish between systolic and diastolic dysfunction.

    01:01 Now, couple of things here that become important once again to bring in a little bit of physio.

    01:07 Let us begin. So here let me set this up for you. On these graphs that you are seeing, couple of important curves that you are paying attention to. We are strictly dealing with diastole.

    01:20 Now, this first curve that you are seeing on top represents the aortic pressure and the left ventricular pressure and you'll noticed that we are now moving down. The only thing that this is showing is the relevance of diastolic interval or diastole with your cardiac cycle along with left ventricular volume. This is really important for you to understand because well, any exam or any attending might then ask you what is going on with diastole? Why is this true? Well, first and foremost, once we begin isovolumetric relaxation, here you come down and where it says your AVC at the bottom of that graph, that's your aortic valve closure. Welcome to what heart sound? Second heart sound. Are you now clear about where we are? You have just closed your aortic valve. What are you going to begin? You tell me.

    02:13 Isovolumetric relaxation. So isovolumetric relaxation and you are moving down this hill very very quickly. And as you do so, what is going to happen when your left ventricular pressure is below your left atrial pressure? MVO is mitral valve opening, and as soon as that mitral valve opens, the blood from the left atrium is going to gush into left ventricle.

    02:36 It cannot be any more dramatic. So now what happens? You are going to find a rise in left ventricular pressure as you do there. And right now everything that you are seeing is in red, everything you seeing in red represents diastole. The bottom picture represents left ventricular volume. So as the blood quickly comes into left ventricle as soon as the mitral valve opens, guess what happens to left ventricular volume? Obviously increased. And in the mean time the atria is just completely emptying, and as you move all the way to the right and you are just about to start your systole and just about to start your isovolumetric contraction, you will have your a-wave, which kicks in the last bit of blood, right. Your a-wave and then you have your mitral valve here closure, at the beginning of your isovolumetric contraction. Please make sure that you are completely comfortable of integrating the different curves of your cardiac cycle. It is imperative that you do that please. Otherwise, you might be asked questions, you might be put into situations from the graph while you are spending time perhaps even wasting it where every second is so incredibly precious.

    About the Lecture

    The lecture Diastolic Dysfunction by Carlo Raj, MD is from the course Heart Failure: Basic Principles with Carlo Raj.

    Included Quiz Questions

    1. Left ventricular filling defect
    2. Right ventricular filling defect
    3. Loss of atrial kick
    4. Pump defect
    5. Deficient preload
    1. Isovolumetric relaxation
    2. Isovolumetric contraction
    3. Passive filling
    4. Rapid filling
    5. Ejection
    1. v wave
    2. p wave
    3. a wave
    4. qrs complex
    5. y descent

    Author of lecture Diastolic Dysfunction

     Carlo Raj, MD

    Carlo Raj, MD

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