Decreased diastolic compliance

I've been having increasing chest discomfort (fullness) and dyspnea on exertion. Also deep bilateral pitting edema, along the shins above the ankles. Minor cyanosis of nail beds and lip edges, as well.  CT, lung x-ray, abdominal ultrasound, all within normal limits (save for some thickening of the gall bladder wall.)  Echocardiogram indicated "abnormal mitral inflow pattern, suggesting decreased diastolic compliance", but everything else seemed normal (didn't get good views of the LV). Was tachycaric throughout exam. Thalium stress test in 1992 showed "mottled area of decreased perfusion in the left ventricle" and "no areas of reversible ischemia." No treatment offered then. Having a new cardiolite stress test next week.

I know that decreased diastolic compliance means my ventricles aren't relaxing enough to allow complete filling.  Could this be a cause of my symptoms, and if so, could medication alone resolve this?

Thank you!

[CCF-M.D.-MJM]

Hello,

If you have significant diastolic dysfuntion, it would certainly cause fatigue, lower extremity edema.  The cyanosis is bit perplexing, especially if you are not in heart failure.  If  you truly have cyanosis.  I would look to confirm it with an exercise stress test with pulse oximetry, consider a blood gas to check your base line oxygenation status if you are hypoxic during exercise.  You didn't mention that you were a smoker so I will assume that you are not.

Other things that may cause this lower extremity edema and cyanosis include shunts.  If you have an ASD, VSD, large PFO -- you have be shunting blood from from a sick right ventricle to the left ventricle.  A good echocardiogram would clarify this.

Medications may or may not help depending on the cause of the diastolic dysfunction and whether or not you are shunting.  A diuretic will usually help the lower extremity edema except in extreme cases.  Otherwise the goal to treat the underlying cause of the diastolic dysfunction -- usually hypertension.

I hope this helps. Good luck.

[nih_radioguy]

Thanks, Doctor.  I used to be a very heavy cigar smoker, but I've cut back to 2 -- perhaps 3 per week.  Last time I had my sats checked, I was at 95 percent on room air.  EKG normal.  I guess we'll see what comes from the Cardiolite stress test.

Thanks again.

[LacyMary]

Hi there.  If I am not mistaken the Blood Gases are different than the Oxygen check they do via the finger. This is what was told to me 3 weeks ago in the hospital.  They did both on me.  I have Systolic anterior motion (LVOT)dysfunction and they are trying to figure what to do with me.  Good Luck to you.

[nih_radioguy]

Thanks, Lacy.  Yeah, I know for blood gases, they need to drill into an artery.  Not fun.  Good luck with your condition, and thanks again!