Echocardiography Techniques III Exam 1 Practice

Pseudonormal grade II diastolic dysfunction occurs when the LV filling pressures are elevated enough to hide the underlying relaxation impairment, so the mitral inflow pattern looks deceptively normal. The key clue is E/A in the typical range for normal flow (about 1 to 1.5), which would suggest normal function if you only looked at velocity ratio. But tissue Doppler tells the real story: e' is reduced, reflecting impaired myocardial relaxation. The elevated filling pressures are then confirmed by a high E/e' ratio (greater than about 14), and chronic pressure loading shows up as enlargement of the left atrium (elevated left atrial volume index). Together, these findings reconcile a seemingly normal E/A with true diastolic dysfunction and elevated pressures.

The other patterns don’t fit pseudonormal. A pattern with very high E/A (over 2) reflects a restrictive, advanced filling pattern with markedly elevated pressures, not the pseudonormal state, and while E/e' can be high, the overall signature is different. A very low E/A with disproportionately high e' isn’t typical of this stage, since high e' suggests better relaxation contrary to the impaired-relaxation picture. Finally, an E/A around 0.7 with normal e' and a low E/e' points to normal diastolic function rather than elevated pressures or pseudonormalization.