Pulmonary hypertension

[Akajo]

Hi

I am 35 years old . Two and half years I became pregnant (first pregnancy). Some time during the end of the first trimester I started having palpitations 140/min and chest discomfort . I used to have this for a long time, I but dind’t bother about it. My gyneac referred me to a cardiologist. I underwent an echo which showed the following reading :

Tricuspid valve : Ev =0.57m/s, A = 0.54m/s, trivial TR, Tr jet vel = 2.9m/sec, RVSP = 35+10=45 mmHg

Pulmonary valve :Vmax :1.08m/s, No PR

The report gave a report of
(1) diastolic dysfunction probably rate related
(2) Moderate pulmonary hypertension

My BP was 170/100 normal and 140/90 at rest when I underwent the echo. But it was always normal during the gyneac check-up. I was put on Concor 2.5 mg twice a day.

I took a second opinion. The doctor said such findings are common during pregnancy due to extra fluid in the blood and it cannot be taken as pulmonary hypertension.

Just before my delivery I underwent holter ECG which confirmed high heart rates, but said there was no problem. I was off concor 2.5 mg.
I had a normal delivery.

One year after my delivery I consulted the cardilogist who took and Echo and said everything was normal. I don’t have the measurements, just the report saying every thing is normal.

I don’t have palpitations, or chest discomfort now when I am rest. Moderate physical activity brings out breathlessness

Now, I have two questions :
(1)Was the diagnosis correct in the first place? If so, how can the disease disapper suddenly?
(2)Will I get this problem again if I become pregnant?

Thanks for your help,
A.Jones

[Akajo]

Thanks doctor

[National Jewish Health]

With an increase in blood volume and cardiac output during pregnancy, borderline pulmonary hypertension (PH) can occur, in the absence of other causes of pulmonary hypertension.  However, there is an increased risk of silent deep vein thrombosis and venous thromboembolism commonly called clots to the lung during pregnancy, especially in black women, but  with all women with maternal age >35 and/or maternal obesity.

In addition, the increased volume and blood flow can aggravate pre-existing conditions such as cardiomyopathy, mitral valvular disease, otherwise mild or borderline primary pulmonary hypertension and portal (liver) vein hypertension, to produce clinically significant PH.

If the above causes of PH were excluded, the assumption that the mild increase in PH you experienced was simply pregnancy related.  And, yes, there would be an increased risk of recurrence, with another pregnancy.  Given this it would be prudent to have a cardiologist consultation and close follow-up from the earliest time of pregnancy through a month or two of the post-partum period.