pulmonary hypertension

[WV2NJ]

One radiologist looked at an x-ray and thought it indicated COPD.  However, the lung specialist didn't think it looked too bad.  I had an echocardiogram which indicated trace regurgitation in the mital valve and physiological regurgitation in the tricupsid valve.  The pumonary artery pressure was also elevated and was 30.  I am seeing the lung specialist again for the breathing tests.  What questions should I ask?  Does it appear that I have pulmonary hypertension?   I am getting very short of breath with a little exertion.  It is becoming very difficult to breathe.  Thanks.

[National Jewish Health]

The x-ray may show signs suggestive of chronic obstructive pulmonary disease (COPD) but it is an insensitive way to make the diagnosis.  The valvular data, on the echocardiogram, are either within normal limits or close to it.  The pulmonary artery pressure has 3 components:  systolic, diastolic and mean pressure.  Systolic is the pressure when the right ventricle of the heart contracts and expels blood into the pulmonary artery.  Diastolic is when the ventricle is relaxed and not contracting.  Mean is the average pressure, over each cycle.  The upper limit of mean pressure is 19 mm.  Upper limit of normal systolic pressure is in the high 20's.  Your pressure of 30 would be mildly elevated if it is the mean pressure.

One can have secondary pulmonary hypertension with COPD in this range but one can see much higher levels with primary pulmonary pressure.

You should ask the lung specialist if the number 30 is systolic or mean pressure, is it truly elevated or could this be a technical error.  Was the ECHO technically satisfactory or should it be repeated.

You should ask if your exam and/or breathing test indicates lung disease, and if so, is it obstructive or restrictive.  If obstructive, is it asthma or COPD or another obstructive lung disease?  If the problem is primarily lung disease, what is the nature of the disease and, in the lung specialist's estimation, is it severe enough to account for the amount of shortness of breath you are experiencing.

Ask if the pressure and your shortness of breath could both be on the basis of recurrent pulmonary emboli, commonly called clots to the lung.

There are many causes of pulmonary hypertension and establishing the cause may require collaboration between the pulmonologist and a cardiologist.  There are pulmonary hypertension clinics at many academic institutions.  You might want to check on this at your nearest university hospital.

Good luck.

[maggiemag]

An echo can only give you an estimate of pulmonary pressures, and only systolic.  A right heart cath is the only way to obtain a mean pressure, and an accurate PA pressure.