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Forum Name: Valvular Heart Diseases

Question: mild TR and PAH RVSP 31 mm Hg


 maddy09 - Mon Nov 23, 2009 4:15 am

Hi

Am 31 yrs male recently i went through the ECHO test he below are the findings

Mild TR and PAH. RVSP 31 mmHg
PULMONARY ARTERY: Mild PAH
DOPPLER STUDY: Mild TR.RVSP 31 mmHg.

The doctor told its nothing to worry and its a very mild stage. i go for jogging daily and do wait lifting havent noticed any fatigue or breathlessness.i do understand one need to go for RHC for any DX on PH

But could you please let me know how do i bring these RVSP values down? i have a tendency towards high blood pressure would that cause RVSP.

I have already posted this query couple weeks back but it seems it didnt get through.Requesting the MODERATOR to aprove this post please

Regards

Maddy
 John Kenyon, CNA - Wed Dec 02, 2009 10:34 pm

User avatar Hello -- While echocardiography is not the gold standard for diagnosis of PAH, the results of your exam warrant your being followed or perhaps even being subjected to more specific testing to be certain this is what's happening and if there is an underlying cause or if it's a primary condition (assuming the diagnosis is correct). As it stands right now your doctor has said it's mild, and the problem with this is either it is mild and the echo is absolutely correct and so is the interpretation, or it's an erroneous finding and there's really nothing to worry about. PAH, as you likely know now, is usually progressive, so the sooner it is diagnosed precisely and treatment is begun, the better the outlook. As for what you can do on your own, the main thing is to remain fit and healthy as possible. You're tolerating the small, suggestive degree of possible PAH well right now. It may not progress or may be very slow in progressing, if it's actually present. I'd want to know more certainly, though, because early medical treatment can often delay or prevent significant progression.

So aside from taking good care of yourself via healthy living and levels of fitness, the other thing you can do is press for more accurate diagnostic testing. Other than that there's really not much you can change, add or subtract.

I hope this is helpful. Good luck to you. Please follow up with us here as needed.
 maddy09 - Thu Dec 03, 2009 12:46 am

Hi John Kenyon,

Thank you vey much for your kind reply,
Am a follower of your write-ups here and realy appriciate the way you explain the things detailsy.
OK coming back to the issue i have,well i do agree"While echocardiography is not the gold standard for diagnosis of PAH"
When i went for the follow-up yesterday the Doctor told i can go for the echo after 6 months are so.
I have been already put on belalock 25 mg for the Hypertension/irregular heart beat but as it didnt help much on lowering hyper tension(BP reading is still 130/90) they have put me on thiazide 12.5 mg

So i have the following Queries here

1)what are all the more accurate diagnostic testing i can press for? ( If am not wrong RHC is the ony way to confirm PAH i beive if its so then is it advisale for me to go for RHC? given to the fact that am only 31 yrs old)

2)is the medicine i have been prescribed for is accurate to control my BP (only my diostol pressure is slightly high @ 90)

Thanks in advance

Warm Regards

Maddy
 John Kenyon, CNA - Tue Dec 08, 2009 12:24 am

User avatar Thank you!
There is a threshold for invasive testing for PAH, and yes, RHC is the appropriate and most accurate way to determine for sure if that's what's going on. The determination as to when to do RHC is somewhat controversial, and the reason is that if the problem progresses slowly or reverses, the patient has been subjected to an invasive study for no really good reason. However, if you are greatly concerned you certainly could bring this up to your doctor and see where he stands on doing early RHC. If there is nothing found you then could relax completely about this issue.

The medication you're currently taking for blood pressure control is appropriate, but ideally the diastolic pressure would be a little bit lower, so perhaps the dosage needs to be upped one notch. Other than that everything seems to be in good order.

Please stay in touch and keep us updated.
 maddy09 - Mon Dec 21, 2009 6:16 am

Hi John Kenyon,
Thiis to follow up with the previous post,I just consulted another cardio specialist, he took my echo again and the below are the findings

Trivial Tricuspid Regurgitation
RVSP 19

I think this virtualy rules out PH, he advicesd me too go for d-dimer blood test which gave negative (120 mg) result.
Follow are the query i have

1) What could be the cause for Tricuspid Regurgitation how do we isolate it

2)The Doc has changed by BP pills and put me on amloozaar H (previously i was on Betablocker/thiazide)

3)will taking a Multi CT scan will help in identifying the cause for Tricuspid Regurgitation

Pls advice

Thanks in advance

Maddy
 John Kenyon, CNA - Fri Jan 01, 2010 10:48 pm

User avatar Hello again. The RVSP of 19 does, indeed, seem to lay to rest any concerns about PH. This is an excellent number. It also renders moot, for now, any concerns about the tricuspid regurgitation, which is a fairly common finding, especially the trival sort, which appears in the majority of normal, healthy patients. It is simply an artifact that must be noted because it is not considered "normal" by textbook standards. A CT wouldn't reveal anything new about the valve and, in fact, one with "trivial" regurge is pretty much a normal one.

This is all good news and its sounds as if a lot of worry can be let go now. Good for you! Please keep us updated.

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