I think you overwhelmed the poor kid.
Diagnosis of diastolic heart failure by cardiac ultrasound is controversial...as evidenced by numerous position statements in JACC as of late.
Just to clarify a few points:
Two most commonly used indices of diastolic dysfunction are:
1) E/A ratio (measured by conventional 2D echo)
2) E/E' ratio (E' requires tissue doppler Echo)
***the caveat here is that these indices are flow dependent and rely heavily on preload, relaxation, and the integrity of the EKG rhythm.
Basically, all indexes of myocardial early and late diastolic properties are derived from trans-mitral flow patterns. Other indices, including dT or relaxation time are helpful but, are not as powerful independent predictors of the presence or absence of diastolic dysfunction.
Where the controversy lies, is that patients with pulmonary and peripheral edema (of cardiac origin) will be called "diastolic heart failure" by default if the Echo shows a normal EF despite normal E/A and E/E' ratios. This just isn't so, and I caution you on jumping to this conclusion. Certainly you can bill it that way a la ICD-9 codes, however, it is important to conceptually understand the difference in pathophysiology as it affects long-term management.
There is now a third emerging classification,
Heart Failure with Normal EF, which I would encourage you to read more on. It makes sense that 2D ECHO does not adequately quantify the 3-D movements (transverse, longitudinal, and spiral) of the heart in many patients.
WndrWmn10 said:
However, I still don't understand how to make a diagnosis based on an 2D echo (they never just say systolic vs. diastolic on the report), and whatever other signs and symptoms they have.
No one would expect this of you. Nor would they expect this of a medicine resident. Even Cardiologists often cannot make the diagnosis based on the Echo for numerous reasons (suboptimal images, inadequate visualization of cardiac segments, acoustic windows, etc.).
There is a JAMA "Rational clinical exam" article from 1997 assessing the accuracy of the physical exam in diagnosing systolic vs. diastolic dysfunction. The most powerful independent predictor of diastolic dysfunction was "currently elevated BP." This paper is somewhat dated, as it assumed that all heart failure with a normal EF is "diastolic." It is worth a read however, in that it discusses common clinical findings in systolic and diastolic dysfunction.
This is a lot for a 4th year to chew on...also a heck of a topic to present in 5-10 minutes.
Good luck.