Pulmonary Hypertension?! Please help!!

[JesterK1]

I am sure hoping you can help...  I am a 32 y/o female athlete, 5'4", 129 lbs., healthy diet/nonsmoker/nondrinker who has been having heart palpitations (PVCs, PACs) with/without activity and was seen for them over the past two weeks.

Might it be worth mentioning, on occasion, approx. 6-8 hours or even a day after strenuous runs/lifitng, I feel a band of tightness around my upper stomach/lower chest. This was checked out about a year ago with thorasic CT with contrast, EKG, pulmonary capacity/function test (no asthma), bloodwork, etc.. to no avail; doctors indicated the issue was chest wall in nature and musculoskeletal.  If I take a few days off, symptoms go away.  Recently, I went through barium swallow testing and stomach emptying tests.  Doctors indicated that I have a sliding hiatal hernia.

Due to the palpitations, a precautionary stress echo and full resting echo (with bubble perfusion) were performed last week by my request.  The cardiologist indicated that the stress echo was normal with an above average capacity for exercise.  However, the resting echo came back with PFO/ASA, and mild mitral and tricuspid regurgitation.  He assured me that they were benign, and cleared me to full activity (strenuous job) and athletics (running and competitive powerlifting).  I received his report, letter and notes today in the mail, only to find that in addition to the above findings, the resting echo report indicated a mPAP of 27mmHg (with an upper end normal range of 25), and a RVSP of 35mmHg (with an upper end normal range of 30-35).  The pulmonary valve velocity was 1.2 (apparently 1.0 is normal).  The report cites "mild pulmonary hypertension".  I had a fit and called the doctor's office only to find that my cardiologist is not on call. I cannot sleep and am beyond upset and worried.  I am so scared...  Can you help me make sense of this?

Thank you so much!

[Lee Kirksey, MD]

Hello
How are you? Ill first begin with my general opinion on the story that you presented. Several of the measured values that you described from your echo report were at a top-normal range. The mPAP was mildly elevated. This does not indicated that you are in any imminent medical danger. I am generally reluctant to comment on values like this because we interpret those numbers in the context of a big picture that weighs heavily on your examination, history and other factors. Additionally, an echo is a perfect example of a test that follows the principle "a picture is worth a thousand words". I have personally seen echos with your values that were little more than an individual variant of normal likely influenced by your physicial activities. I suspect that this is what your cardiologist thought or else he would have certainly made mention that he was concerned

I suspect that you are very conscientious of health given your activities. I would not immediately jump to conclusions and worry about this discovery. Instead, give your cards office a call tomorrow and ask to discuss the results of the exam. Inquire if he believes that the mild pulm hypertension is activity related, does it pose any long term harm and will it affect the progression of your mitral and tricuspid regurg over time.
Those are the pertinent questions and they all reflect concerns over a long term not tonite or next week.

As you know, you place your body under relatively "abnormal" stress by the intrathoracic, intra abdominal and intracerebral pressures that are generated with powerlifting and some other exercising. You want to ask your doctor if any of these changes will affect your measured physiology.

Good luck and best of health

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