Exercise-induced PH and high BP

Thank you for taking my question on above subject. Would so appreciate advice.

Given 2 diagnoses on visit to PH Clinic:
#Exercise-induced pulmonary hypertension.
#Systemic hypertension.
'Inadaquately controlled needing more agressive treatment,'as printed on report.

Third echo since Nov 04, this at PHClinic, normal left 'side' at rest incl RV size and function. Est. RV S.Pressure; 32 mmHg (BP 158/90) inc. to 60 mmHg (BP 184/82)at peak exercise(supine bike). Ejection fraction response to stress from 65% at rest to 75% peak stress. LV end-systolic volume decr. with stress. There was an exc-induced increase in tricuspid regurgitant peak velocity, 2.6 to 3.7m/s (RV S-pressure: 32mmHg to 60, assuming RA pressure of 5mmHg).

Still don't understand what above means in relation to 2 previous Echos (posted 01/30). Also wonder why PH Clinic didn't do a RHC to be sure, mostly was reason we traveled so far. May the reason have been my blood pressure was high; or fact that I had adverse reactions to Versed/Demarol after a TEE attempt, this year, locally?

PH Clinc increased my 120mg diltiazem to 240mg daily, with suggestion of increase to 360 mg, and advised me 'PH does not appear to be a feature of my symptoms or current situation'.

Two weeks following my visit, new PHP prescribed Lisinopril 2.5mg AM, diltiazem 120mg PM. I track my blood pressure as advised; in the range of 145/80 pulse 75. I weigh 134lbs, 5'5", don't smoke/drink, am 60. Exercise around the house and use stat. bike. Sometimes my BP reaches 180/95 for no reason. Worry so about all this.

MBT

[CCF-M.D.-MJM]

Hi MBT,

Sorry to hear about your health problems, but must admit I am not sure that I am getting the big picture from the information provided.

I am not clear why you have the pulmonary hypertension?  I see two reasons from what you mentioned:

1. chronic hypoxemia, although it would be important to know what your oxygen saturation does with excercise and at rest.  If you are truly hypoxemic, the next logical question is why are you hypoxemic.  Is there a pulmonary problem or is there a cardiac shunt.  This is a very important question to answer and I agree that I right heart cath would help answer this question -- if it is done correctly.

2. Your mitral regurgitation may also be contributing to the pulmonary hypertension.   Wither exercise and increased blood pressure, mitral rugurgitation may increase and transmit the increased pressure to your pulmonary circulation.  

Unfortunately, I don't think I am answering your question but only repeating it in a different way.  I agree you need to find an answer.  If you are not satisfied with the answer your are receiving, consider obtaining a second opinion elsewhere.

I hope this helps.  good luck.

[MBT]

Hope it is ok to post this, as had not more space.

From 30/1

1/05 ECG:
Mitral valve thickened w/o restriction. Moderate (2+) mitral regurgitation
Right ventricle mildly dilated. Mild right ventricular hypertrophy.
Right atrium mildly dilated
Tricuspid valve thickened w/o restriction. Mild (1+) tricuspid regurgitation. Estimated pulmonary artery systolic pressure is 55 mmHg
No pericardial effusion or intracardiac shunts
IMPRESSION:
Moderate mitral regurgitation
Mild tricuspid regurgitation
Mildly dilated and hypertrophied right ventricle
Moderate pulmonary hypertension

11/04 ECG:
Mild mitral regurgitation. Mitral valve appears anatomically normal.
Right atrium: normal
Tricuspid valve: trace tricuspid regurgitation. Estimated pulmonary artery pressure is 68 mmHg. Moderate pulmonary hypertension

12/04 PFT
Mild restrictive ventilatory defect. Question if this is related to her body habitus/obesity (noted height of 64 inches and 134 pounds). Also noteworthy: diagnosis given for complete PFT - pulmonary hypertension - question findings related to same. Clinical correlation is suggested.
Abnormal at rest arterial blood gas and pH determination with evidence of moderate hypoxemia. PaO2 was 26 mmHg less than that calculated for her age & position.

[hbp702]

Obesity has nothing to do with it in this case.

134 pounds and 64 inches = Body Mass Index (BMI) of 23

This is considered normal.

Even in cases of obesity, people with Pickwickian syndrome or other obesity associated respiratory problems usually have a BMI of 40 or above.

[axg9504]

Please tell me the following: 1. What tests were run to determine your exercise induced pulmonary hypertension. I think it looks like an echo afer riding a bike?? 2. What symptoms do you have when you exercise that are due to the PH.
3. How much exercise do you have to do to get to that point when you are having these symptoms. 4. Do you have any problems at rest or during normal activities. Thanks, this could help me with some symptoms I am having. I am the same age as you..

[bj317]

A related discussion, Should I be concerned was started.

[Mollyfrise]

A related discussion, Will I need surgery? was started.