Echo results possible mild PH

I'm a 47 yr old male 5'8" `165 lbs. My blood work is spot on. I had an echo 3 weeks ago for heart palpitations. The findings were all normal except for "borderline PA pressure" of 36. ejection faction was 55% right ventricle diameter was 2.7 cm. I am concerned about having the start of PH. There is no family history.  I am in good shape with absolutely no symptoms. I work out and race dirt bikes all without a problem. My cardiologist was not concerned. Should I get additional tests and if so what tests should I look to have done. What is the likely hood of developing PH? Several years ago I had a sleep study done which revealed minor sleep apnea which did not require treatment.   Thank you for your help.

[skydnsr]

You could have a transesophegeal echo (TEE) to get a closer look at your heart valves, but I don't think I would want to go there at the moment.  The TEE is an invasive test, and it's not pleasant.  Right now, it doesn't sound like an invasive (and expensive) test is really justified.  But you have the palpitations, as well as the mildly elevated PA pressure, so it does sound like something is going on that could potentially progress, and in your situation I would want my heart to be monitored in the future.  

As a lay person but as one who has bicuspid aortic valve disease, I can tell you that what you are presenting is consistent with a BAV.  I am not telling you that that's what you have, because  obviously I don't know that.  I just know that your age and symptoms are consistent with BAV among other possibilities, and it's something that you could keep in the back of your mind.  Sometimes with BAV, the aortic valve itself at this stage can still look normal on an echo, so again that's consistent with the overall picture that you are describing.  

If the palpitations bother you, the doctor can give you medication for that -- probably a beta blocker.  You'll want to use the lowest dose of the beta blocker that controls your symptoms.  Beta blockers have long term side effects, so if it were me, I would want to titrate down to the lowest effective dose.  

Also, in your situation I would want to be followed yearly by a cardiologist and would want to repeat the transthoracic echo on a regular basis, probably once a year.  If you do have a BAV, it will eventually reveal itself as abnormal on a future echo, because the valve will deteriorate over time.  If it's not a BAV that you have, then you still need to keep an eye on the pulmonary valve and watch for any changes in anything else.

I've got a couple of questions for you.  How's your blood pressure?  Also, do you have any family history -- even in the very extended family -- of valve disease, aneurysms, congenital heart disease, or sudden cardiac death?  Wait, here's a third question for you:  this is a long shot, but did you yourself, by any chance, have any heart problems at birth or in childhood that later cleared up?    

[skydnsr]

You could have a transesophegeal echo (TEE) to get a closer look at your heart valves, but I don't think I would want to go there at the moment.  The TEE is an invasive test, and it's not pleasant.  Right now, it doesn't sound like an invasive (and expensive) test is really justified.  But you have the palpitations, as well as the mildly elevated PA pressure, so it does sound like something is going on that could potentially progress, and in your situation I would want my heart to be monitored in the future.  

As a lay person but as one who has bicuspid aortic valve disease, I can tell you that what you are presenting is consistent with a BAV.  I am not telling you that that's what you have, because  obviously I don't know that.  I just know that your age and symptoms are consistent with BAV among other possibilities, and it's something that you could keep in the back of your mind.  Sometimes with BAV, the aortic valve itself at this stage can still look normal on an echo, so again that's consistent with the overall picture that you are describing.  

If the palpitations bother you, the doctor can give you medication for that -- probably a beta blocker.  You'll want to use the lowest dose of the beta blocker that controls your symptoms.  Beta blockers have long term side effects, so if it were me, I would want to titrate down to the lowest effective dose.  

Also, in your situation I would want to be followed yearly by a cardiologist and would want to repeat the transthoracic echo on a regular basis, probably once a year.  If you do have a BAV, it will eventually reveal itself as abnormal on a future echo, because the valve will deteriorate over time.  If it's not a BAV that you have, then you still need to keep an eye on the pulmonary valve and watch for any changes in anything else.

I've got a couple of questions for you.  How's your blood pressure?  Also, do you have any family history -- even in the very extended family -- of valve disease, aneurysms, congenital heart disease, or sudden cardiac death?  Wait, here's a third question for you:  this is a long shot, but did you yourself, by any chance, have any heart problems at birth or in childhood that later cleared up?    

[taragox]

Thank you for your reply. Fortunately there is no history of heart problems on either side my family. My blood pressure is great @110 over 70 with a resting pulse rate of 70. I've never had any heart problems, my doctor has always said I have a strong sounding heart. These palps started 1 week after I started taking otc joint medicine chondroitin. I stopped after a week and a half, but the palps never went away. They have gotten better.  The echo did show mild tricuspid regurgitation, trace mitral regurgitation and no aortic regurgitation. The doctor offered me metoprolol but I declined unless it gets real bad. Do you think I would have symptoms @ this PA pressure if it was something serious? Pulmonary Hypertension was the first thing that popped up when I did a search and it is such a devastating disease it scared me. I have scheduled a consult with another cardiologist for a second opinion and would like a follow up echo in a year. Thank you

[skydnsr]

No family history, good blood pressure, all valves functioning well -- maybe the PA thing is just one of those flukey incidental findings.  Maybe it's something you would have lived all your life without knowing about, if you hadn't had this ultrasound.  If the palps are getting better, and if they're not bad enough for you to want to take metoprolol, maybe you can wait 'em out, and maybe they'll go away.  I don't know what to think about the palps starting shortly after you started taking chondroitin.  I guess you could do some internet research on chondroitin and see if there are any references to it's causing heart palpitations.  Let us know what the 2nd opinion doc says, if you don't mind, because you've got my curiosity up.  Good luck with this, and try not to worry too much.  

[skydnsr]

PS, I know I said "all valves functioning well" when you have mild tricuspid regurgitation and trace mitral regurgitation, but it's mild and trace.  A lot of people probably have a one or two valves that are mild or trace, and they never know it.  Sometimes with these tests, they turn up stuff that doesn't do anything for you but give you something to worry about.  I'm hoping that's all your echo results amount to, and I'm hoping the palps go away.

[skydnsr]

Okay, one more thing.  I know pulmonary hypertension is a horrible disease, but it's horrible because of the level of symptoms and disability that it can cause, and you're not like that.  You feel good, except for the palps, which are getting better.  You can hang onto that reality in your head -- that you're still really okay -- instead of thinking about how horrible your condition "could" (but likely never will) be.  

Also, I can tell you that my PA pressure has been higher than yours for many years, secondary to aortic valve disease, and I'm nowhere near feeling like those horror stories that you read.  I'm also nowhere near as athletic and fit as you are, but then again I never was.  I'm 59 years old and nondisabled.  I work full time, I feel okay, and I do whatever kind of recreation I want to do.  

So don't get the idea that whatever is going on with your heart has put you on the slippery slope to an early geezerhood.  It's just a deal that's probably going to end up meaning anything from absolutely nothing to just being a condition that you will have to have a cardiologist to help you manage.  I'm sorry, but at age 47, it's not unusual to start acquiring "conditions," lol -- if that's even what happens with this thing.

[CCF CCF]

It sounds like you are taking good care of yourself and should not be concerned with this finding.  You should definitely follow up on your sleep apnea because if it becomes worse you should be treated to avoid cardiovascular consequences including pulmonary hypertension.  However if you continue preventive care as you are you may never develop worsening PH.  

[taragox]

Thank you for you reply and insight. Its nice to talk to people that have the same emotional and physical feelings. I'm not alone. I'm not concerned about the mild valve leakage. I understand that much of the population has it. You're right I may have had this pressure for years. Its quite high compared to the normal range so it concerned me. Hopefully its nothing. My appt for the second opinion is Feb 21. I'll let you know what his feelings are.  Thanks again