Diastolic dysfunction differential diagnosis

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Differentiating Diastolic dysfunction from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby


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

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 an S4 gallop[1]

Differentiation of Restrictive Cardiomyopathy with Associated Diastolic Dysfunction from Constrictive Pericarditis

The Diagnostic Parameters that are Similar Between Restrictive Cardiomyopathy with 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 Diastolic Dysfunction, from Constrictive Pericarditis

Mitral Inflow Velocity Pattern
Respiratory Variation in Mitral E Velocity
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


  1. 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.
  2. 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.

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