Causes of enlarged right ventricle

[kgrelish1155]

My mother is 86 years old and has been diagnosed with pulmonary hypertension.
She has severe tricuspid regurgitation and an enlarged right ventricle.  She also has atrial fibrillation.  The right artery is 100% blocked and has been for very many years.  She has 40% blockage of her main artery to the heart.  She does not have any other problems with her valves and all her other arteries are fine.  The symptom I also noticed was that my mother was always on blood pressure medicine to lower her blood pressure and suddenly (very suddenly) she does not require blood pressure medicine - her blood pressure is now predictable about 110 to 115 over 60/50.  What caused the change in her blood pressure readings so suddently - nobody seems to be able to answer this question for me.  

Suddenly (as it seems) she has developed pulmonary hypertension.

My question:  Is the pulmonary hypertension causing the right ventricle enlargement and the tricuspid regurgitation and would this then be primary pulmonary hypertension. Or, can you explain what is causing her pulmonary hypertension.

I have been told my my mother's cardiologist that her tricuspid regurgitation is causing the pulmonary hypertension. But I have talked to other doctors that tell me that the pulmonary hypertension is causing the tricuspid regurgitation.

Can you help me through all of this confusion so that I can help my mother?










This discussion is related to Right Ventricular Enlargement, Moderate Tricuspid Insufficiency.

[kenkeith]

A 40% blockage of main artery is usually not considered medically significant.  

The 100% blockage of the RCA, obviously there is a natural bypass with collateral vessel growth, may cause heart cell damage that impairs heart wall movement and the stress can dilate (enlarge) the right ventricle.

A common etiology of tricuspid regurgitation is dilatation of the RV cavity.
The valve structures are normal; however, because of enlargement of the cavity and dilatation of the annulus, proper coaptation of the leaflets is not possible.
Causes of the dilatation include mitral stenosis, pulmonic stenosis or regurgitation, PULMONARY HYPERTENSION, dilated cardiomyopathy, and RV failure.

QUOTE: My question:  Is the pulmonary hypertension causing the right ventricle enlargement and the tricuspid regurgitation and would this then be primary pulmonary hypertension. Or, can you explain what is causing her pulmonary hypertension.

To answer your question pulmonary hypertension can enlarge the right ventricle and valve regurgitation is secondary to pulmonary hypertension. An enlarged right ventricle does not cause pulmonary hypertension (does not constrict or tighten blood vessels).

"Causes of pulmonary hypertension: Pulmonary hypertension results from constriction, or tightening, of the blood vessels that supply blood to the lungs. Consequently, it becomes difficult for blood to pass through the lungs, making it harder for the heart to pump blood forward. This stress on the heart leads to ENLARGEMENT of the heart and eventually fluid can build up in the liver and tissues, such as the in the legs. Affected patients can sometimes notice increasing shortness of breath and dizziness".

I don't have an answer regarding systemic blood pressure return to normal readings.  Ideopathic high blood pressure means cause is unknown, and it is possible I suppose to return to normal at not know the cause although I have never heard that happening.