Echo Results

[guadamom]

I ‘m 52 w/heart valve problems below.Get left chest pain,short of breath,difficulty walking/talking same time.Get winded with normal activity.Take Imdur 60mg, Norvasc 2.5mg, Mevacor 20mg & fast acting nitro as needed.I have Microvascular Angina & recently Pulmonary Hypertension.I’ve had 5 echos,listed last 2 below. Per Heart Assoc. normal pressure is 14 mmhg at rest.Echo on 11/2007,pressure at rest is 57mmhg & 62-67 mmhg at peak.Echo on 12/2007,pulmonary artery pressure is 32 mmhg within normal range.  Pulmonary doctor states my pressure is within normal limits, but will not verify if I have PPH .My question “Is this normal range for diagnosis of PPH?”  Please tell me when or what I need to know or if I would need a valve replacement & do I have PPH?

Stress Echo on supine bicycle 11/2007 Summary:
Exercised 9 min 26 sec. heart rate increased 78-148. Systolic pressure increased from 100-166. Double product at max exercise was 24,568.  Electrocardiographic tracings became abnormal & near exercise there was flat down sloping ST segment depression in II, III, AVF & V3-V6. Abnormalities persisted beyond 8 min of recovery. Resting echo images demonstrated normal left ventricular size & systolic function. Ejection fraction 65%. Mild mitral insufficiency & moderate tricuspid insufficiency. Tricuspid insufficiency jet allowed estimation of right ventricular systolic pressure at rest at 57 mmhg & near peak exercise at 62-67 mmhg.
1. Normal stress echocardiographic study demonstrating no evidence for exercise induced regional wall motion abnormality.
2. Resting pulmonary hypertension is present with normal physiologic increase right ventricular systolic pressure with exercise.

Bubble Echo 12/11/07 Brief Summary:
Est. left ventricular ejection fraction is 70%.  The aortic, tricuspid & mitral valves are normal morphologically.  Color flow Doppler demonstrates 1-2+/4 mitral regurgitation. Est. pulmonary artery pressure is 32 mmhg which is within the range of normal

[maggiemag]

Echos can be off by a large amount.  30 would be considered the upper limit of normal for an echo systolic pressure.  The only way to tell if you have pulmonary hypertension is a right heart cath.  Primary PH (PPH) is diagnosed after multiple tests are done looking for and ruling out a  secondary cause.  Lupus, Scleroderma, sleep apnea, mulitple pulmonary emboli, etc. are all possible causes of PH.  Left heart problems also can cause pulmonary venous hypertension leading to pulmonary artery hypertension, and the treatment for that is to treat the left heart problem.  Mitral regurg means left heart problems.  The usual workup involves sleep studies, CAT scan of the chest, tons of labwork, pulmonary function tests.  Have you seen a pulmonologist first?  Your EF is normal, but why do you have persistent EKG changes after 8 minutes of recovery and they still say it was a normal stress echo?  That doesn't make sense to me even though you had no regional wall abnormality.  Hope this helps some!

[guadamom]

Thanks.  Yes I have been seen by a pulmonologist and he ordered all test and ruled out all above. He decided against RT heart cath since all test came back normal. My concern is my 1st echo finding on 11/2006: Three Cusped Aortic Valve & Mitral Valve mildly thickened., Ejection Fraction  60%.
1. Normal Left Ventricular size & Systolic Function.
2. Moderate Mitral Regurgitation.
3. Mild to Moderate Tricuspid Regurgitation.
4. High Normal Right Ventricular Pressure.  
5.  Trace Pulmonic Regurgitation.  

Echo on 11/07:  as stated above - Systolic function pressure 57mmhg & 62-67mmhg, So my Cardio referred to Pulmonologist. He ordered all test and Echo of 12/07 above and but does not say if I have Pulmonary Hypertention. According to Heart Assoc normal pressure should 14mmhg.  And yes I am concerned why doctors did not metioned EKG changes aftter 8 mim and don't understand what Flat down sloping ST segment depression in II, III, AVF & V3-V6 mean?  I'm currently being treated for Microvascular Angina spasm of small arteries. Doctors have not been straight with me.