Estimate pulmonary artery pressure of 25-35 - is it high

[Dentalmaniac]

My stress echo report says that estimate pulmonary artery pressure is 25-35 during rest as well as after excercise. Are these levels high. Am i at risk of pulmonary hypertension? Appreciate someone's response.

thanks

[amihilis]

I had an echo done to see if a heart murmur was harmless or not. My murmur was fine and everything with my heart was good except my pulmonary artey systolic pressure was at 35. I am freaking out. Is this treatable and what can I expect? Thanks

[kenkeith]

The 25-35 would be the systolic PAP range. A finding of a systolic pressure of 35 on the echo with the rest of the heart chambers within normal range is usually not a cause of concern and additional testing. However, if you are having shortness of breath, and if there is no other reason for your symptoms, then a right heart catheterization would be the test to actually measure the pressures.

Measurements of lung volumes are important to confirm or clarify the nature of lung disorders. The flow volume loop may indicate an obstructive or restrictive or obstructive/restrictive pattern, but a further test of lung volume is often necessary for clarification.

If your condition at the time had an obstructive lung condition such as airway obstruction (ie chest cold) causes an increase in resistance. There is a breathing, pressure,  and blood volume relationship.   During normal breathing there is a pressure and volume relationship so when the increase in the effort to breathe that can cause an overdistention of the lungs and prevent an acceptable measurement of pulmonary pressure.  There may be other obstructive causes, etc.
Hope this helps.

[Dentalmaniac]

Thanks kenkeith for your detailed response. I went to my cardiologist today to discuss this report and he totally brushed my questions off on this. His response was this is totally normal. I asked him if this was the systolic pulmonary artery pressure or did the range mean it was diastolic and systolic and he responded with well as your normal blood pressure has ranges so does this. I told him how i had heard a mean of higher than 25 means PH and he said well your values are within normal range. I asked him if there's anything i can do to make my values better and his response, you can't make anything that's already normal more normal. I know I'm a bit of a hypochondriac but felt like he completely brushed away my questions. Can you tell me if the values shown on my echo result would be diastolic and systolic as they're being shown as a range 25-35. Also he said well these values are just an estimate. I asked him how my echo done five years ago at another place said systolic pulmonary artery pressure could not be estimated and his response was well we are so good at our facility that we were able to estimate it. Can someone please tell me why the pressure would not be measurable at one time and could be measured at a later time.

thanks so much.

[kenkeith]

For some insight pulmonary artery pressures (PAP) paramenters: As you know there is an exercise and resting parameters for pulmonary arterial hypertension (PAH). The exercise parameter has a mean (average)  ≥ 25 mm Hg at rest and 30 mm Hg with exercise. However, making the diagnosis of PAH can be difficult. For a more definitive measurement a right heart catheterization is necessary because the exercise echocardiogram has limitations, namely the inability to measure left-sided filling pressures and  cardiac output (stroke volume) that is in part needed for evaluation..... " found that athletes have a higher pulmonary artery systolic pressure (PASP) with exercise than nonathlete volunteers (approximately 50 mm Hg vs < 30 mm Hg) and that this difference is in part because of a higher stroke volume in the athletic cohort".  The fact there was no induced PAH with your stress test is good sign there is no  problem.

Pulmonary hypertension generally results from constriction, or stiffening, of the pulmonary arteries that supply blood to the lungs. The higher resistance makes it more  difficult for the heart to pump blood forward through the lungs. This stress on the heart leads to enlargement of the right heart and eventually fluid can build up in the liver and other tissues, such as the in the legs.

Your question about the  risk of PAH would depend on the underlying cause. You did not include any information regarding symptoms, etc. The risk for PAH are (ie, family history, setting of associated conditions such as connective tissue disease) or in whom there is no other explanation for the dyspnea (shortness of breath), for those patients objective exercise measures of decreased performance (ie, cardiopulmonary stress test and/or 6-minute walk test) should be considered for bringing about exercise-induced PH (you have no induced PH!).

Thanks for sharing and if you have any further questions feel free to ask.  Take care.