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Triphasic mitral inflow documented by Doppler echocardiography and cardiac catheterization: a case study
Ikuo Misumi1, Kenji Ebihara, Ryuichiro Akahoshi
1Department of Cardiology, Kumamoto Saishunsou Hospital, Japan. misumi@saisyunsou1.hosp.go.jp
Internal Medicine (Tokyo, Japan)
|March 23, 2011
Summary
This case study highlights triphasic mitral inflow patterns in patients with diastolic dysfunction, revealing unique left ventricular pressure dynamics during impaired diastolic filling.
Area of Science:
- Cardiology
- Medical Diagnostics
- Physiology
Background:
- An 85-year-old woman with hypertension presented with chest pain.
- Echocardiography revealed left ventricular (LV) hypertrophy, reduced systolic function (ejection fraction 40%), and mitral regurgitation.
Observation:
- Pulsed Doppler revealed triphasic mitral inflow velocity.
- Simultaneous LV and pulmonary artery wedge (PAW) pressures showed elevated mean PAW pressure with a prominent v wave.
- LV pressure exhibited early diastolic elevation, a mid-diastolic decrease, and late diastolic elevation exceeding PAW pressure.
Findings:
- The mid-diastolic decrease in LV pressure, despite filling, was attributed to abrupt inflow volume increase from impaired diastolic function.
- This pressure behavior deviates from conventional pressure-volume relations in diastolic dysfunction.
Implications:
- Triphasic mitral inflow is a characteristic indicator of diastolic dysfunction.
- Understanding these unique LV pressure dynamics is crucial for diagnosing and managing diastolic heart failure.
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