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Borderline Pulmonary Hypertension
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Borderline Pulmonary Hypertension

I am a 45 year old female.  I went to the doctor because of fluid build up in my legs and abdomen, weakness and shortness of breath.  The doctor ordered an echocardiogram.  It says the following:

Left Ventricle:
The left ventricle is normal in size.
There is borderline concentric left ventricular hypertrophy.
The left ventricular wall motion is normal
Ejection Fraction = 60-65%

Right Ventricle:
Normal right ventricular size and systolic function

Atria:
The left atrial size is normal
The right atrium is borderline dilated.
IVC collapses with inspiration
A patent foramen ovale is suspected

Mitral Valve:
The mitral valve leaflets appear mildly thickened.
There is trace mitral regurgitation.

Tricuspid Valve:
The tricupsid valve is normal in structure.
There is trace triscupid regurgitation
Right ventricular systolic pressure is 43 mmHg
There is borderline pulmonary hypertension

Aortic Valve:
Normal

Pulmonic Valve:
Not well visualized

Great Vessels:
The aortic root is normal size

Pericardium/Pleural:
There is no pericardial effusion

I am concerned with the diagnosis of "borderline pulmonary hypertension" because I took Fen-Phen for approximately 6 months before it was discontinued.  Can you tell me what is "borderline pulmonary hypertension" and will it progress to pulmonary hypertension?  Can that be prevented?

Thank you, Terry
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The left side of the heart is associated with systemic blood pressure, and the right side involves pressures associated with the pulmonary valve, pulmonary artery, and the lungs.  It is accepted any value greater than 40 is in the range of pulmonary hypertension.
In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. Pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and heart failure.

In order to establish the cause, the physician will generally conduct a thorough medical history. A detailed family history is taken to determine whether the disease might be familial. A history of exposure to cocaine, methamphetamine, alcohol leading to cirrhosis, and smoking leading to emphysema are considered significant. A physical examination is performed to look for typical signs of pulmonary hypertension, including a loud P2 (pulmonic valve closure sound),  jugular venous distension, pedal edema, ascites, hepatojugular reflux, clubbing etc. Evidence of tricuspid insufficiency (pulmonary valve regurgitation/stenosis) is also sought and, if present, is consistent with the presence of pulmonary hypertension.

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Thank you for the information, not what I wanted to hear, but I have made an appointment with a cardiologist to get further advice.

Terry
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Keep in mind that transthoracic echocardiogram isn't a replacement for right heart cath.   Studies have shown that pulmonary pressure is not always accurate and why they call it an "estimate"    There are many possiblities for an enlarged right atrium but again is an estimate.   Higher pulmonary pressure can also be physiologic when even slight pulmonary stenosis is present.   Pulmonary stenosis in itself typically doesn't need treatment.  

The cardiologist may recommend getting a right heart cath if they feel the pulmonary pressure is indeed a real issue.   Only then can you be sure the level is actually high.
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Thank you for your response.  It made me feel a little better.  I have an appointment with a cardiologist on the 23rd, but my GP did not seem to be overally concerned and just said we will do another echo next year to see if it worsens.  I don't want to be sitting on my thumbs waiting for something to happen and besides that I am still having shortness of breath with little activity and weakness.  Do you know if GERD or hiatal hernia could cause mild pulmonary hypertension?  I have been diagnosed with both as well as being anemic.

Thanks, Terry
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Evidence of GERD causing pulmonary hypertension hasn't been proven; however sleep apnea sometimes accompanies GERD and can cause PH.    They can always do a sleep study to confirm.   There are numerous causes of SOB and every possibility is usually checked before pulmonary hypertension is diagnosed.   Typically it is a diagnoses of elimination of other causes.   Sometimes it is idiopathic or genetic.

Also, doing another echocardiogram may or may not be useful as technicians will have some variance in the interpretation.   The pulmonary pressure is an indirect measurement they take from tricuspid insufficiency.   Keep in mind that almost everyone has trivial/mild tricuspid insufficiency.   They use this measurement because the tricuspid valve is seen as a "blow off valve" for pressure buildup when the pulmonary arteries are restricted.   This is also why persons with pulmonary stenosis will show artificially raised PA pressures.   They may have also been assuming RV pressure of 10mmhg and not taking that in account for the 43mmhg measurement.   Your cardiologist will know best and always consult that person before advise from others!
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