55 year-old woman, with LV hypertrophy and moderately dilated left atrium. TTE, apical 4C view, mitral inflow pulse Doppler patterns. A. Mitral inflow pattern appears "normal" at rest. B. During Valsalva maneuver the E/A ratio decreased from 1.3 to 0.6 and peak A velocity increased from 60 to 75 cm/s, unmasking the impaired relaxation pattern.