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Forum Name: Cardiology Diagnostics

Question: Echo results


 s salzlein - Fri Aug 27, 2004 6:29 am

Hello,
I am a 31 year old female, had an echocardiogram done for a newly heard murmur. My primary Dr. said basically that everything came back normal. However, now that I see the report on paper...results say L atrial size is normal, right atrium is slightly prominent. L ventr. EF is 70%, mild mitral and tricuspid insufficiency, pulmonary hypertension, with a R ventricular pressure of 45mmHg. In your opinion, would this warrant a follow up with a cardiologist? Or does it fall in the "normal" range? I have since become pregnant and my OB wanted to see the report, that's why I am just now looking at it. Thank you, Shannan
 Dr. Yasser Mokhtar - Thu Sep 09, 2004 4:58 pm

User avatar Dear Shannan,

You have pulmonary hypertension which means high pressure within the pulmonary circulation.

This is oversimplification of things but pulmonary hypertension is of two types:
1. Primary: Of unknown cause.
2. Secondary: Main causes are either cardiovascular (related to the heart and the blood vessels) or pulmonary (related to the lungs including blood clots to the lungs if you had any).

The echocardiogram should have shown any obvious cardiac causes of pulmonary hypertension but it did not. So, we will assume that your heart is not the cause. The causes that are related to the blood vessels have to be investigated by doing some blood tests. So, assuming that you don't have lung disease including previous blood clots to the lungs and the blood tests come back negative, you might have primary pulmonary hypertension. Remember that i said that this is oversimplification of things.

Your profile says that you had a c-section in the past, so i assume you had a pregnancy that went on well and ended by delivery of the baby at full term.

i don't know though whether this is your first echo or not. If this is your first echo then we don't know what was your pulmonary pressure status during the first pregnancy but i assume you had a full term pregnancy which means that at that time, your heart was ok.

With pregnancy several cardiovascular changes occur and there is strain on the heart with its peak around the 26th-28th week of pregnancy and if you have any heart problem you might go into heart failure and the problem with pregnant females is that they look like they have heart failure (they ar short of breath and they have edema of the legs) and sometimes it is not easy to differentiate.

In my opinion, pulmonary hypertension is not something that should be dealt with lightly and go without being investigated and followed-up carefully.

My recommendation to you at this point is to see either a cardiologist or pulmonologist according to your primary care physician preferrence.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 s salzlein - Sat Sep 11, 2004 8:52 am

Dr. Mokhtar,
Thank you for the reply. Yes, my last child was full term, and there were no complications. I'm wondering if strenuous exercise can cause the pulmonary hypertension? This echo was done last Nov.(first and only echo) and I was training for the Disney Marathon. I'm not a fast runner, I would just stay at a nice easy steady pace, but I was doing long durations. Although, I didn't run for about a week before the echo. Is it also possible that the hypertension was already there and the exercising just exaggerated the pressure? My primary didn't recommend any follow up or anything, said that it was basically normal. That's why I didn't take care of this until now (26wks pregnant). It's the first time I ever saw the report. Thank you again! Shannan
 Dr. Yasser Mokhtar - Sat Sep 11, 2004 10:31 am

User avatar Dear Shannan,

Thank you very much for the update.

Actually, pulmonary pressures increase just a little bit during exercise in response to the increased blood volume that passes through the pulmonary circulation. Pulmonary pressures should not reach that high.

My recommendation is still at least to get an echocardiogram at this point and to see where your pulmonary pressures stand.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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