Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

Figure 1 Phases of left atrial function. Left atrial preload is determined by blood flowing from the pulmonary vein. In this initial filling phase the LA acts a reservoir storing blood during left ventricular systole against a closed mitral valve. During LV diastole, diastasis and as the mitral valve opens it acts as a conduit, passively using stored energy to empty into the LV. Finally, in LV end diastole the LA contracts and actively empties blood completing the LV filling cycle. Reprinted from Karayannis et al[21], with permission of the publisher (Copyright © 2007, Springer Science + Business Media. Authorization for this adaptation has been obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation). LA: Left atrial; LV: Left ventricle; Vp: Left atrial volume before atrial contraction; Vmax: Maximal volume (as defined at left ventricular end-systolic phase); Vmin: Left atrial minimal volume (as defined at left ventricular end-diastolic phase).