Diastolic Dysfunction Diagnosis

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The diagnosis and treatment of isolated diastolic failure is often a challenge, since the symptoms are so similar to systolic heart failure. It is important to distinguish between diastolic heart failure (caused by diastolic dysfunction) and systolic heart failure (caused by systolic dysfunction), as the treatment for one condition can aggravate the other condition.

Diastolic heart failure is caused by a fault in the organ’s filling mechanism, but the systolic function or contraction mechanism is preserved. Therefore, although the condition may be characterized by typical symptoms of heart failure, the ejection fraction is normal in patients with diastolic dysfunction. The ejection fraction refers to the percentage of blood that is pumped out of the heart with each heartbeat or cardiac cycle.

An outline of the steps taken to diagnose diastolic dysfunction is given below:

A detailed history of the patient’s symptoms is obtained and a clinical examination is performed. Long standing illnesses such as diabetes or hypertension can predispose to diastolic dysfunction Aortic stenosis is another condition that can lead to the condition and a doctor may listen to the chest using a stethoscope to check for the sound of an abnormal heart beat.

Echocardiography with Doppler can be used to diagnose diastolic dysfunction. This technique uses sound waves to provide real-time imaging of the heart’s structures and blood flow during a cardiac cycle. This is a routine and painless examination. Echocardiography can also be used to determine the heart’s ejection fraction.

Some of the parameters that are assessed during echocardiography to check for evidence of diastolic heart failure include:

  • Pulmonary vein flow patterns
  • Mitral inflow velocity patterns
  • Tissue Doppler measurements
  • M-mode echo measurements that are used to assess the size of the left atrium. The left atrium is often enlarged due to the backflow from the left ventricle when it fails to fill adequately.

Using Doppler echocardiography, diastolic heart failure can be classified into four grades, which include:

Grade I – The E/A ratio is reversed on the mitral inflow echocardiogram. This is the mildest form of diastolic heart failure and is referred to as an abnormal relaxation pattern. Patients are usually asymptomatic.

Grade II – This diastolic dysfunction is characterized by increased filling pressure in the atrium and is considered to be moderate stage disease. The left atrium may also increase in size due to the increased pressure.

Grade III – This is a severe form of diastolic dysfunction characterized by restrictive filling of the heart that leads to symptoms of advanced heart failure. When the patient is asked to perform the Valsalva manoeuvre during echocardiography, the diastolic abnormalities seem to reverse. This grade III dysfunction is therefore also called reversible restrictive diastolic dysfunction.

Grade IV – This is also a severe form diastolic dysfunction characterized by restrictive filling. However, at this stage, the abnormalities are not reversible and grade IV diastolic dysfunction is also called “fixed restrictive diastolic dysfunction”.

Further Reading

Last Updated: Jul 6, 2023

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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  1. Kim Deaton Tainsky Kim Deaton Tainsky United States says:

    Dr Ananya Mandal,

    My 10 yr old daughter was recently diagnosed with diastolic dysfuntion.  She has had cardiac anomalies since before birth. Presently, she has mvp w/regurgitation, leaks in the tricuspid valve, aortic valve, pulmonary valve, and enlarged right ventricle (prenatal).  the left atria was slightly enlarged a year ago but now is normal in size.  

    How rare is dd in children with ongoing heart defects since birth?
    She is taking Atenolol for ventricular ectopy with couplets (diagnosed 1 year ago).  I understand that the medication she is on will also treat the dd.  

    At what point does something like this resolve in children? or is this something she will have her whole life?  

    How much do we know about pediatric diastolic dysfunction?

    Thank You,
    Kimberly Tainsky

  2. Shirley Gasaway Tucker Shirley Gasaway Tucker United States says:

    I just found out that I have Grade 1 (Mild) Distolic Disfunction and my Cardiologist further sta?ted my heart is "stiff".  I had a normal LV ejection fraction on the Echo.  My question is two fold.  In reading about it, there is a progression up to Grace 4.  Can you tell me if this progression has been studied and a time line extablished?  Next, is there treatment, meds., or surgery that can help patients with this disease?  I have had a heart attack several years ago and have Coronary Artery Disease.  Thank you for any information you can give me.  Shirley

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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