Pulmonary Hypertension

[MBT]

Thank you. Had an ECG 1/05; also one 11/04 when admitted to hospital with SOB and low BP. Also pulmonary function test in 12/04. Would appreciate knowing what it all means. Please explain the difference between the two ECGs and conclusion given on the PFT. Have omitted normal results. I take CCB+325mg aspirin daily since Dec; previously Atenolol 25mg.

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.

MBT

[Cleveland Clinic]

MBT,

The result you provide are from an echo, not ecg.

The concerning primary problem revealed in the data you provide is the diagnosis of pulmonary hypertension which means that you have elevated pressures in blood vessels that move blood from the right side of your heart to your lungs.  On the last echo, this pressure elevation this has caused changes in the ventricle that has resulted in dilation of the right side of the heart.

The PFTs show that your lungs do not expand as well as they should meaning they have some restriction.  There are a lot of factors that can cause this such as obesity and intrinsic lung disease. The PFTs are only a marker of this.  The blood gas basically states the same non specific thing.  

The bottom line is this is a concerning diagnosis.  There are multiple causes of pulmonary hypertension.  The basic way I break it down is that problems with the heart (such as valve disease), problems with the lungs (such as sleep apnea and pulmonary fibrosis) and problems with the blood vessels themselves (such as with scleroderma and vasculitis) can all cause pulmonary hypertension. These are known as secondary causes and fixing the underlying cause can often stave off the progression of the disease.  Primary pulmonary hypertension is a diagnosis in itself, after all other causes have been ruled out, with specific modalities of therapy.

There is a very straightforward evaluation of pulmonary hypertension. At this point I would seek a cardiologist or pulmonologist skilled in treating patients with pulmonary hypertension for your care and diagnosis.

good luck

[jan]

My last echo had "mildly elevated pulmonary pressure".  The previous echos I had all had the mild mvp, mild MR and TR.  From what I understand the PP is diag by the TR, so does anybody know why it was only noted on this echo?  The cardio said I would have another echo in 5 yrs to check on it and doesn't show too much concern, but everything I come across seems to say this is serious.  Is it serious?  Is it ok to wait 5 yrs?

(I am on bisoprolol and verapamil ER for IST and NCS. I see cardio ep every 6 mos.)

I am wondering too, if it is coincidental that both parents had emphysema later in life and neither ever smoked.  I can think of reasons why ea. might had developed it, but wonder if it's anything.

Anybody know?

[DottyCece]

I am not sure if this helps but I have had mild and moderate Pulm HTN secondary to severe TVR.  No one was ever concerned too much about the mild Pulm HTN but they were with the moderate.  I also had severe shortness of breath, very poor activity tolerance, fatigue and so forth so had to have a second open heart surgery to repair this valve.  If you are feeling well and are not short of breath and can be pretty active, if it was me I wouldn't be concerned.  But, if these symptoms develop, I would see the physician for follow up.  

The emphysema in your parents may be something you need to keep in mind but if you don't have any lung disease, I wouldn't worry about it too much and just check in with your primary MD periodically for an exam.

[Momto3]

So glad you posted. I checked out the CCF.org website for more information on the upcoming web discussion re: afib.  If you will not be available during the discussion, you can ask a question (there is a box to fill out) ahead of time. I thought you might like to ask about the percutaneous valve surgery. Once the discussion is complete, the transcripts will be available - online, I think.

Connie