Differential Diagnosis for Restrictive Filling Pattern and Grade III Diastolic Dysfunction
Single Most Likely Diagnosis
- Hypertension: Prolonged hypertension can lead to left ventricular hypertrophy, which is a common cause of diastolic dysfunction and restrictive filling pattern. The septal e' of 10 cm/s and lateral e' of 15 cm/s support this diagnosis, as they indicate impaired diastolic function.
Other Likely Diagnoses
- Coronary Artery Disease: Ischemia or infarction can lead to diastolic dysfunction due to stiffening of the ventricular wall. The presence of a restrictive filling pattern and grade III diastolic dysfunction could be indicative of significant coronary artery disease.
- Diabetes Mellitus: Diabetes is known to cause diastolic dysfunction through various mechanisms, including myocardial fibrosis and advanced glycosylation end-products. The restrictive filling pattern and impaired e' velocities are consistent with diabetic cardiomyopathy.
- Heart Failure with Preserved Ejection Fraction (HFpEF): This condition is characterized by diastolic dysfunction, often with a restrictive filling pattern, and can be caused by a variety of factors including hypertension, diabetes, and obesity.
Do Not Miss Diagnoses
- Amyloidosis: Although less common, amyloidosis can cause restrictive cardiomyopathy, which presents with a restrictive filling pattern and diastolic dysfunction. It is crucial to consider this diagnosis due to its poor prognosis and the availability of specific treatments.
- Constrictive Pericarditis: This condition can mimic restrictive cardiomyopathy and is important to diagnose because it may be treatable with pericardiectomy. Differentiation often requires additional imaging and hemodynamic studies.
Rare Diagnoses
- Fabry Disease: A genetic disorder that can lead to diastolic dysfunction and restrictive cardiomyopathy due to the accumulation of globotriaosylceramide in the myocardium. It is rare but important to consider due to the availability of enzyme replacement therapy.
- Sarcoidosis: Can cause restrictive cardiomyopathy and diastolic dysfunction through granulomatous infiltration of the myocardium. It is a rare cause but should be considered, especially in younger patients or those with systemic symptoms of sarcoidosis.
- Hemochromatosis: Iron overload can lead to restrictive cardiomyopathy and diastolic dysfunction. Although rare, it is an important diagnosis to consider due to the potential for treatment with iron chelation therapy.