Mild Pulmonary Hypertension

Question

Hello, I'm a 22 year-old medical student. I have had a PDA correction procedure at the age of 1,5 years and mild intermittent asthma since childhood. No other heaIth conditions. I don't smoke and drink alcohol moderately. I have no family history of heart disease, I have no diabetes or hypertension. I had no worrisome cardiac symptoms since childhood. Recently, I've done an echo for regular check-up and was told, that I have a mild Pulmonary Hypertension, max. PAP = 38-40 mmHg. Also a trace of MR and TR. My heart is otherwise normal - normal chamber sizes, EF = 67%. My GP told me, that this is not a serious problem and I should not be worried. I also have been evaluated by rheumatologist and had some blood tests. The Antinuclear Antibody was slightly elevated, but I also had the Anti-DNA test and it was negative. There were no LE cells found in my blood. So, Lupus was excluded.
I am still worried about that mild hypertension, cause I know, that early correction of PDA and mild asthma are not associated with Pulmonary Hypertension. Also, I live an active life and when I have PAP 38-40 mmHG at rest, it will be much higher when I exercise or play soccer. Please, suggest me if you have any ideas about this. 
Thank You !

markmsn10 · Accepted Answer

It is entirely not uncommon for normal people to see elevated PAP in an echo-- the only gold standard is right heart cath. They discount this as a fluke when no evidence such as right heart/atrium enlargement accompanies the pressure estimate. Also it is based off of tricuspid insufficiency (which everyone pretty much has) depending on the amount it will reflect a higher PAP. Anything below 35mmhg is normal but even seen others listing PAP as high as 50mmhg to find out it is actually normal at 25 mmhg when doing a right heart cath.

Guka_MD · Answer

Thank you for your support and very useful information ! Wish you get better soon !

jbowdish · Answer

Hello, sorry its taken awhile to get back to you. My Ph Doc said I have Primary PH. Yes I believe that people can have mild elevations from an echo, thats why if all possible its best to see a PH specialist and always get a second opinion if you believe one doctor could be wrong. My daughter for instance, her cardiologist has told me for 8 month's my daughter didnt have PH. I went and had a second opinion to find out she truly does have it. Also some people may only experiance symptoms with activity. My first symptom was shortness of breath with activity and then as the disease has progressed I have extreme fatigue,dizziness,SOB, chest pains, etc now. Also it was RVSP of 55 mmhg for mine. Hope this helps! PH can get so confusing because there is so much to be learned from it still!

Guka_MD · Answer

Thank you for this very useful information !

markmsn10 · Answer

This may be useful.   Excerpt from the site below:

Doppler ECHO overestimated directly measured PASP by more than 10 mmHg in about 50% of patients without PH and in 30% of patients with PH. Similar findings have been observed in other cohorts of patients at risk for or with known PH, including a cohort of PAH patients from our center.

Cited:

http://www.phaonlineuniv.org/Journal/Vol7No4Winter08-09/RoleOfEchocardiography

markmsn10 · Answer

Keep in mind that sometimes they add 5 to 10 mmHg to the estimate (assuming RA pressure)   So that number may be 5 to 10 lower than what is actually stated.   An expert can correct me if I'm wrong on that.    PAP may not be the mean estimate-- there is some grey area in reporting for some technicians in this regard.

Guka_MD · Answer

One more thing - your PAP, 55mmHg, is this max. systolic or mean PAP ?

Guka_MD · Answer

Thank you for your wish to help others ! :) Now, I want to know, what do the doctors say about the cause of you PH ? Is it primary or secondary ? You say that you didn't have any heart problems, Lupus and RA are also excluded... So, it seems that you have a primary PH, doesn't it ? and one more question - I have read this on different sites and sources, that "It is common for normal people to see elevated PAP on an echo" and some mild elevations can be considered normal, if there are no serious symptoms and there is no evidence of RV failure or cardiac chamber enlargement. What do you think ?

jbowdish · Answer

My Pulmonary pressure is 55mm hg. I am taking leteiris and Tyvaso which is 2 of the stronger meds. Yes I have improvent but not alot yet. I went from Feb to Nov with no treatment due to insurance problems and doctors not agreeing. I started treatment in Dec 2010. I had no previous heart problems but my blood work showed possible Lupus or RA. The second test for blood work I had was negative for both. I also have trace of TR and MR. I will say my daughter has just been diagnosed with Mild PH with pressure being 37 mmhg. We are getting ready to take her to a childrens hosp, as I mentioned before PH is very serious. Not all doc's will say that, but ask any PH specialist and they will tell u the same thing. Also I should mention when I have activity my PH pressures rise. I want to mention that mild PH starts at 25 and up. They even do heart cath's while exercising on a bike to see if pressures are up during activity because for some ppl it only rises during activity. Any more questions Id be happy to help!

Guka_MD · Answer

A very reasonable opinion... Thank you !

Guka_MD · Answer

Thank you for suggestion.

Guka_MD · Answer

Thank you for support. Please tell me, what was your max. PAP and do you have any improvements after starting the therapy ? Did you have any heart problems or autoimmune disorders before developing the PAH ?

jbowdish · Answer

I think you should see a Pulmonary Hypertension Specialist. I have Moderate PH and the sooner you get help the better. You want to stop this disease from getting worse cuz you do not want it progressing since there is no cure. My PH doc said its better to start treatment in the beginning then waiting. http://www.phassociation.org/  is a great site to get help. Please check it out