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Heart Disease (Expert Forum)
PH? and misc. ?'s
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
PH? and misc. ?'s
by jan, Dec 29, 2005 12:00AM
Dear Dr.
History: I am a 49 yr old F, not over wt., don't smoke or drink. Am more or less sedentary. I have mild MVP, w/mild MR and TR. I am being treated for IST and NCS. I am on 81 mg. of aspirin for Factor V Leiden, I have Raynaud's and misc diag. Meds: verapamil,atenolol, misc. My mother had a double bypass and MVR and yrs later died of CHF at 75. Her sister died of a "weak heart" after giving birth to a "blue baby" at around 30, her bro. died at 42 from a stroke. Mom and Dad had emphysema late in life and never smoked. I don't know if any of that is relevant.
My last echo 2-3 yrs. ago said "mildly elev. pulmonary pressure". My ? is, all the other echoes had TR, but never mentioned this. What are the chances I really have it? Could this be incorrect? My new PCP wants to do another echo to see if it's chg'd and maybe send me to a pulmonologist. What do you think? (In the past I've been told my lips were purple. I get sob w/o the tachy). What tests should be done? When/Should I see a pulmary dr. or ph spec.?
The other ? is about vague heart attack symptoms, chest pain. I went to the ER 2-3 yrs ago and they thought I was having a heart attack. I had L. upper back, neck, and arm pain and
coincidental EKG chgs. It would feel better when standing.It was C-spine prob. Last night I had sim. pain w/pressure too, but when I sat it got better,when stand'g it acted up again. I didn't go to the ER,because it wasn't a 9 or 10. How do you know when to go?
Another ?,I get PAC's and the other day had 2 that caused near syncope. Why would this happen?
Thanks
History: I am a 49 yr old F, not over wt., don't smoke or drink. Am more or less sedentary. I have mild MVP, w/mild MR and TR. I am being treated for IST and NCS. I am on 81 mg. of aspirin for Factor V Leiden, I have Raynaud's and misc diag. Meds: verapamil,atenolol, misc. My mother had a double bypass and MVR and yrs later died of CHF at 75. Her sister died of a "weak heart" after giving birth to a "blue baby" at around 30, her bro. died at 42 from a stroke. Mom and Dad had emphysema late in life and never smoked. I don't know if any of that is relevant.
My last echo 2-3 yrs. ago said "mildly elev. pulmonary pressure". My ? is, all the other echoes had TR, but never mentioned this. What are the chances I really have it? Could this be incorrect? My new PCP wants to do another echo to see if it's chg'd and maybe send me to a pulmonologist. What do you think? (In the past I've been told my lips were purple. I get sob w/o the tachy). What tests should be done? When/Should I see a pulmary dr. or ph spec.?
The other ? is about vague heart attack symptoms, chest pain. I went to the ER 2-3 yrs ago and they thought I was having a heart attack. I had L. upper back, neck, and arm pain and
coincidental EKG chgs. It would feel better when standing.It was C-spine prob. Last night I had sim. pain w/pressure too, but when I sat it got better,when stand'g it acted up again. I didn't go to the ER,because it wasn't a 9 or 10. How do you know when to go?
Another ?,I get PAC's and the other day had 2 that caused near syncope. Why would this happen?
Thanks
Doctor's Answer
by CCF-M.D.-MJM, Dec 29, 2005 12:00AM
Hello Jan,
Those is a lot of complicated questions. I will try to answer them -- but my answer will be incomplete because more information is needed.
Could this be incorrect?
It is probably correct. The significance of the pulmonary hypertension depends on how high it is. We don't worry to much about the lower range of pulmonary hypertension in the 36-40 range, but would follow it over time. You should see a specialist to figure out why.
What tests should be done? When/Should I see a pulmary dr. or ph spec.?
V/Q scan look for chronic thromboembolic disease. It is possible you are having small chronic PEs and need coumadin.
Echo with bubble study to rule out a small hole in your heart.
CT scan to evaluate for interstitual lung disease
An HIV test is usually done to rule out HIV related PAH
Rheumatology usually evaluates for rheumatic or inflammatory causes like scleroderma, lupus, rheumatoid arthritis (and a long list of others)
How do you know when to go?
That is a tough call. If you have new onset of chest pain you should be evaluated. If you have a recurring chest pain that has been evaluated found to be not cardiac or pulmonary related, you probably don't need evaluated everytime. This is a decision you should discuss with your doctor so you are both comfortable with it.
I get PAC's and the other day had 2 that caused near syncope. Why would this happen?
You should talk to your doctor about a holter monitor to figure out exactly what is happening when these events occur. It may be more than a PAC or completely unrelated.
It sounds like you have several potentially complex issues going on. I think it is time to see some specialists.
I hope this helps and thanks for posting.
Those is a lot of complicated questions. I will try to answer them -- but my answer will be incomplete because more information is needed.
Could this be incorrect?
It is probably correct. The significance of the pulmonary hypertension depends on how high it is. We don't worry to much about the lower range of pulmonary hypertension in the 36-40 range, but would follow it over time. You should see a specialist to figure out why.
What tests should be done? When/Should I see a pulmary dr. or ph spec.?
V/Q scan look for chronic thromboembolic disease. It is possible you are having small chronic PEs and need coumadin.
Echo with bubble study to rule out a small hole in your heart.
CT scan to evaluate for interstitual lung disease
An HIV test is usually done to rule out HIV related PAH
Rheumatology usually evaluates for rheumatic or inflammatory causes like scleroderma, lupus, rheumatoid arthritis (and a long list of others)
How do you know when to go?
That is a tough call. If you have new onset of chest pain you should be evaluated. If you have a recurring chest pain that has been evaluated found to be not cardiac or pulmonary related, you probably don't need evaluated everytime. This is a decision you should discuss with your doctor so you are both comfortable with it.
I get PAC's and the other day had 2 that caused near syncope. Why would this happen?
You should talk to your doctor about a holter monitor to figure out exactly what is happening when these events occur. It may be more than a PAC or completely unrelated.
It sounds like you have several potentially complex issues going on. I think it is time to see some specialists.
I hope this helps and thanks for posting.
