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Forum Name: Valvular Heart Diseases

Question: possible pulmonary hypertension?


 alkigirl - Tue Nov 04, 2008 5:20 am

Hi. I am a 32 year old female (5'7", 130 lbs) with a history of bronchitis and asthma that has been worsening within the past year. I recently did an EKG and echo with a cardiologist, as I was recording very high BPMs (180-190) during exercise. Findings from my echo test show that I have pulmonary arterial pressure estimated between 30-35 mmHg (33 was the doctor's estimate) and mild tricuspid regurgitation on my right side. The doctor also noted that a slight (very mild and "nearly unremarkable") increase in size for my right ventricle. My question is, should I be concerned that this is pulmonary hypertension? Are there other possible causes of this type of finding? Everything I have read suggests a diagnosis of PH is a fairly grim prognosis, so I am very scared. I have made an appointment with a pulmonologist, but am having to wait 3 weeks before being seen, and am terrified. Thank you for any insight you can provide.
 John Kenyon, CNA - Wed Nov 05, 2008 10:56 pm

User avatar Hello -

While your findings are very slightly suggestive of something pulmonary, they are also within the generally normal range. The right pulmonary artery pressure is on the high side of normal, given there are no other marked corollary abnormalities, and it seems there are not. "Mild" triscuspid regurge is in itself unremarkable, and borderline enlargement of the right ventricle is also a fairly common finding and something which can vary from study to study.

Your doctor is perfectly reasonable in referring you to a pulmonologist, mainly for the worsening obstructive pulmonary problems (asthma and recurrent bronchitis). Although these can sometimes be the result of pulmonary hypertension, your overall clinical picture wouldn't support such a conclusion at all. On the other hand, these problems, chronically, could cause some of the very slight variations seen in your right heart study, and because of this they, again, do deserve the attention of a specialist.

My guess would be you do not now have nor are you likely to develop pulmonary hypertension. While the pulmonologist may want to follow you over time to see if there are any significant changes, as of now, based on the information you've provided, I don't think you need be worried about pulmonary hypertension. Just be certain you are properly treated for the asthma and recurrent bronchitis, and perhaps (if the doctor feels it's appropriate) plan to be re-evaluated on an annual or semi-annual basis to be sure there's nothing else going on.

Best of luck to you. Please follow up with us as needed here.
 alkigirl - Thu Nov 06, 2008 12:25 pm

Thank you very much for your reply. I should also mention that I have been experiencing occasional dizziness (eg, sometimes standing up from a horizontal position, or standing up "too fast") and SOB/ pounding heart after exercise -- especially taking stairs or walking up hills. This is what has me worried. I never thought much of these symptoms until seeing the cardiology findings so I don't recall how far back they go and therefore can't note if they've progressed.

I also had surgery for scoliosis in 2004 (had an "S" curvature of 55 degrees, now reduced to around 20 with titanium rod.) Could this also create 'false readings' on the echo or EKG that would suggest a favoring of one side of the heart?
 John Kenyon, CNA - Fri Nov 07, 2008 8:20 pm

User avatar Hi -

While the cluster of symptoms, including the new ones you've mentioned, could be grouped under pulmonary hypertension if it were likely, it still seems odd, considering that even if you were in the early stages, you would be unlikely to be symptomatic to this degree, so I am still pretty comfortable with the conclusion that something else is going on.

Also, while the rod correcting the scoliosis shouldn't skew the readings of an echocardiogram, the scoliosis itself might well be responsible for some of the symptoms you're experiencing, due to the changes in pulmonary capacity it can cause in some cases. The ability of the entire thorax to work mechanically in concert can be thrown off to varying degrees by the curvature, which can result, in some patients, in a reduction in vital capacity and a number of other annoying problems.

Given all this, I am even more anxious to hear the results of your pulmonology consult. Meanwhile, try to manage your anxiety over the issue, as the story, thus far, at least, still argues, on balance, against pulmonary hypertension (or cor pulmonale, abbreviated "CP" for future reference). Please keep us updated.
 alkigirl - Sun Dec 28, 2008 12:19 am

Hi Dr Kenyon. I wanted to report back and let you know the outcome of my further testing for PH. Fortunately, after several extensive tests with a PH specialist, and another repeat echo, my doctors do not feel that I present with pulmonary hypertension. Rather, my PFTs showed that my lung capacity was more dramatically impaired by my asthma than I previously thought. I have since been put on a new inhaled steroid medication which has dramatically improved my SOB symptoms. My original heart rate complaint also seems to have lessened, as I am recording bpms in the 120s-160s through workouts now on the whole.

One follow up question I do have, which is still puzzling: my last two echos showed 'trace', or insignificant, pericardial effusion. None of my doctors have a clue what could be causing that, and were a little perplexed. Should I be concerned?
 John Kenyon, CNA - Sun Dec 28, 2008 12:31 pm

User avatar Great news! Thanks for this update. I'm always very happy to learn things are fine and it sounds as though you're already improving. Asthma can be very insidious, which is why it sometimes tricks people into thinking something else is going on and is often misdiagnosed or missed altogether. I'm so glad you've found something that works for you.

As for the trace pericardial effusion, this is actually quite common, and in otherwise healthy people who haven't had heart surgery recently (I'm pretty sure you haven't or that would have come up) it's usually the result of a passing viral infection. It can also be caused in some cases by anatomical anomalies or even persistent fits of coughing, which can, in some people, cause just enough irritation to the pericardium to create a little fluid in there. It usually will resolve on its own, but can also remain visible for a long time, so don't be surprised if, in the future, the same thing is noted again. As long as it remains "trace" and causes no symptoms, it's fine.

Good luck to you and keep up the good work.
 alkigirl - Sun Mar 07, 2010 5:36 pm

Hi Dr Kenyon,
After this post some 18 months or so ago, I wanted to get back in touch with you with an update and a question on some new findings related to this matter.

After my examinations regarding PH (as documented by this thread), I was absolutely fine for 18 months... I even completed a half marathon without much difficulty, and while my heart would still occasionally pound after stair climbing, it didn't really affect me or wind me at all.
Now, I am pregnant with my first child, and about 16 weeks along at this point. I've been a lot more aware of my heart rate since becoming pregnant; indeed it is back to easily pounding upon exertion, with some mild SOB. I know this can be quite normal in pregnancy but because of my previous cardio-history, my OB suggested I get another echo during my pregnancy to make sure all was still well.
My cardiologist's echo findings noted continued mild tricuspid regurgitation, and also very mild mitral regurgitation, with some suspected mitral leaf thickening. My pulmonary pressures were estimated at 34 mmHg, with the highest recorded tricuspid jet at 2.7. The RV looked normal in size as did the LV.
In contrast, my last echo about 12 months ago, showed estimated pulmonary pressures at 25 mmHg with a jet of 2.3.
My cardiologist didn't seem terribly concerned with this finding, as he thought the increased blood flow of pregnancy was accounting for the increased velocity in the tricuspid valve (my flows were all raised across most other valves as well), and thus causing the estimated pressures to be calculated higher.
What is your opinion on this matter? I would love to believe all is well, but being that I am pregnant, I am nervous about possible PH (I know it can have a grim prognosis in pregnant women).
Thanks for your advice on this matter!
 joplin1964 - Sat Jun 19, 2010 11:52 pm

I had an echo in which the cardiologist said all was good except I had excessive pressure on right side of heart. pressure of 48. He said nothing to worry about because it was seen commonly in obese people and if I lost 50 lbs he felt it would go away. Then my Primary care dr got the report and she seemed more alarmed. She had me do a sleep apnea test. My test for that showed I did not have it. She then referrewd me to lung dr for lung function test and arterial gas. A gas was 98% and LFT was 81 (low normal he said) He is sending me back for an echo next month(3 mos after first one) and if pressure is up he said i should have a RHC. Chest xray showed nothing as well. My cardiologist still says it's my weight and does not seem concerned. Who do I believe? I have had EKG's, worn an event monitor, all blood work good. Advice to keep me from worrying myself to death?
 Link_pad - Mon Jun 28, 2010 12:31 pm

Hi,

I had mild Tricuspid regurgitation 5 years ago and now its Severe !!

But i think yours is something else mine was form Endocarditis & pneumonia, I had bordeline RV dilation like you as well last year. Now my Right Heart is very mildy dilated but not signs of pulmenory Hypertension. I would listen to the experts !!

I think TR alone can't cause P Hypertension, but P hypertension can cause Mild TR.

Best of Luck Paddy !!
 beez1953 - Sat Jul 10, 2010 7:35 pm

Wondering if you ever found out if you have PH. Hoping you are well!

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