1.  Case study of a 67 year old hypertensive female with NYHA class II–III dyspnoea and left bundle branch block on ECG, revealing classical echo Doppler findings of pseudonormal filling.
 Case study of a 67 year old hypertensive female with NYHA class II–III dyspnoea and left bundle branch block on ECG, revealing classical echo Doppler findings of pseudonormal filling. (A) Apical four chamber view demonstrating left atrial dilatation. Transmitral Doppler (B1) at rest shows a “normal” E/A pattern; (B2) during the strain phase of the Valsalva manoeuvre E velocity gradually decreases with no significant change in the A velocity; (B3) post-Valsalva there is reversion to the baseline pattern. (C) Pulmonary venous Doppler showing decreased systolic velocity relative to diastolic velocity, and atrial reversal velocity of 40 cm/s (both caused by elevation of filling pressures). (D) Tissue Doppler velocities at the mitral annulus showing reduced Ea velocity (5 cm/s) and increased E/Ea ratio ( =  16). S, D, and Arev, pulmonary venous systolic, diastolic, and atrial reversal velocities respectively.
Philip M Mottram, and Thomas H Marwick Heart 2005;91:
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