Echo results

When I was 14 weeks pregnant I began having palpitations.  I went to my GP who ordered an echo and holter monitor.  He called me two days later and said that my heart was fine, but was concerned with my pulmonary pressures.  I went that day to the cardiologist who did a second echo, at which point they again said my heart is fine (all chambers normal size and function, and normal EF), but they could not measure a pulmonary pressure becuase there was no TR, but my heart rate was 140-150 during the exam.  I was called later that day at home and told to go the the ER to be evaluated for  PE.  I had a CT to rule out PE- negative and BLE dopplers- negative.  I was admitted to telemetry overnight for monitoring and had an echo the next day to try to get pulmonary pressures, which I was told the pressure was 21mmhg.  Two cardiologists read the echo reports and concluded no pulmonary hypertension by echo.  I was then referred to a cardiologist for my heart rate issue.  That cardiologist also reviewed the two echos done at the hospital and said my heart was fine and no PAH.  He put me on a beta blocker to control my heart rate.  After I started taking the beta blocker, I became short of breath.  The cardiologist then ordered a stress echocardiogram to check my heart rate response to the beta blocker.  The test was fine, but my resting RVSP was 27mmgh and at peak exercise it was 47 mmhg.  He said he thought I may have some unrecognized asthma and sent me to a pulmonologist.  I am now almost 18 weeks pregnant and saw the pulmonologist yesterday who said I have exercise induced pulmonary hypertension and mild asthma.  My PFTs showed mild asthma, but normal gas exchange.  I am sorry I do not have all the numbers.  He has put me on flovent for the asthma, but no treatment for the pulmonary pressures.  My question is regarding the pregnancy and PAH.  Is it safe?  No one seems concerned except me!

[Cleveland Clinic]

Your PAH is very mild and from what I understand you were not having any shortness of breath prior to initiating the beta blocker, therefore, as far as the PAH your were completely asymptomatic at 14 weeks.  There is some concern about PAH and pregnancy, but this most frequently applies to moderate or severe pulmonary HTN.  I would stop taking the beta blocker because it is making your asthma worse.  I think the Flovent is ok, although make sure you are on the lowest dose to have the least affect on the fetus.  Your PA pressures do not need to be treated.  I would even say that once your are done with the pregnancy, you should have a repeat echocardiogram and I am alsmost certain that you pressures will be normal.  When the heart rate is evevated and when the cardiac output is increased, as frequenty is the case with pregnancy, those calculated pressures are not a true reflections of what really is going on.  Even 47 mmHg pumonary pressures is still mild PAH.