AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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As a person ages, the Doppler pulmonary vein flow pattern changes from diastolic dominance to systolic dominance. A 30 yo will have a diastolic velocity greater than a systolic velocity. The diastolic and systolic velocities equalize around 50 years old. Elderly patients have a systolic dominance of their pulmonary vein flow pattern.
This Doppler scan exhibits systolic suppression which is abnormal for this patient.
Causes of systolic suppression of the pulmonary vein pattern are high LAP, mitral regurgitation, atrial fibrillation, pacemaker, and mechanical ventilation. Since the A wave velocity is low, mitral regurgitation is unlikely. The rhythm indicates that atrial fibrillation or a pacemaker is not present. Therefore, the most likely cause is an elevated LAP from a stiff LV or diastolic dysfunction.
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