Abstract
Patients suffering from diastolic heart failure represent the majority of patients with cardiac insufficiency. With increasing severity of diastolic dysfunction the role of the pressure in the left atrium (LA) becomes more important. The clinical consequences in critical care scenarios are cardiac congestion or hypotension despite a preserved left ventricular ejection fraction (LVEF). The prognosis in critical care medicine is typically worsened due to congestion, for example by prolonged ventilation weaning periods, especially with uncritical use of volume therapy. Bedside non-invasive diagnostics are performed by echocardiography. Correct performance of the examination together with interpretation of the results in the light of critical care standards, can only be achieved by high level training. An initial general categorization requires at least the determination of the ratio of early (E) to late (A) ventricular filling velocities (E/A) and the ratio of E to early diastolic mitral annular velocity (e'), the E/e' ratio. Therapy is characterized by a narrow margin between hypotension and congestion, which can only be maintained by close monitoring of hemodynamic measurements.