Pulmonary Hypertension??? Please help!!

[JesterK1]

I am sure hoping someone can help...  I am a 32 y/o female athlete who has been having heart palpitations (PVCs, PACs) and was seen for them.  A precautionary stress echo and full resting echo (with bubble perfusion) were performed.  The cardiologist indicated that the stress echo was normal.  However, the resting echo came back with PFO/ASA, and mild mitral and tricuspid regurgitation.  He assured me that they were benign, and cleared me to full activity and athletics.  I received his report, letter and notes today in the mail, only to find that in addition to the above findings, the resting echo report indicated a mPAP of 27mmHg (with an upper end normal range of 25), and a RVSP of 35mmHg (with an upper end normal range of 30-35).  The pulmonary valve velocity was 1.2 (apparently 1.0 is normal).  The report cites "mild pulmonary hypertension".  I had a fit and called the doctor's office only to find that my cardiologist is not on call. I cannot sleep and am beyond upset and worried.  I am so scared...  Can someone help me make sense of this?

Thank you so much!

[Encephalomalcia]

Your doctor will most likely write you a blood pressure prescription for the pulmonary hypertension.  It would not be good to just let it go, because most likely it will increase over time.  

[markmsn10]

Typically PAP and RVSP are equal without RV outflow obstruction or pulmonary stenosis (possibly even increased flow)   They add 10 mmhg (assume right atrial pressure) to come up with this value from the tricuspid jet.

Most likely it is normal and you are fine.   Echo is not the standard for testing pulmonary hypertension as it is an estimate off the tricuspid jet.   The standard is catheterization.   They would only do this if other evidence existed like RV and Right Atrial enlargement.

In the event that your PV pressure is 1.2 m/s it could falsely increase the estimated pulmonary pressures.   I say this because my pulmonary valve estimate was 1.8 m/s which could be considered trivial pulmonary stenosis (which is pretty benign, it may also just be increased flow across a normal pulmonary valve)

Also, mild tricuspid insufficiency is so common; its no wonder people are finding these numbers.   I, myself, have the same scenario as you.   Though my pressure was estimated at 33mmhg.    This is how I know all this... just a ton of research.   Good luck and let me know how it turns out when you hear back!

-Mark

[nickppatel]

These values are really pretty close to average.  I don't have the link on me, but I saw a study recently of a VERY large group of people.  The average pulmonary systolic echo BP was about 28.5 mmHg, plus or minus about 4.5 points (range of around 24 to 33 or so).  The results of this study were confirmed by another very large study (one in Boston, the other in New Orleans).  These numbers assumed a constant of 10.  So to have a measurement of 35, to me, is really not a big deal and is just slightly outside of "average."  Definitely within the 95% confidence intervals.  Plus, if there's no problems w/ the right side of your heart, it's probably a non-issue.  Of course, listen to your doctor, not me, etc etc.

[nickppatel]

Here's a summary of both studies.  You should find it quite encouraging.

http://www.circ.ahajournals.org/cgi/content/full/106/5/e19