Pulmonary Hypertension

[christianirc]

I am a 31 year old, obese female with severe asthma since the age of 16.  I am on maximum therapy (multiple nebulizer medications every four hours, oxygen).  I can't take oral or injected steroids because of an adverse reaction.  About 2 years ago my pulmonologist suggested I may have ph because of a different type of shortness of breath I was having, he called it 'heavy lung'.  I also have pvc's and tachycardia.  My pulse is always above 100 and in one of the episodes caught on the holter, it hovered around 170. Because of the asthma I can't use beta blockers so I am on mexiletine and cardizem la.  I have normal bp so it has been difficult getting the correct amount that doesn't lower the pressure too much.  I have had several echos and a stress test which weren't abnormal at the time (when I asked for a copy, the diagnoses read "above findings are suggestive of hypertensive heart disease")  

About a month ago I went to my pcp because of edema and increased s.o.b. at night.  He did an echo and it found the following: Ejection fraction is 54%. Doppler suggests no aortic stenosis.  Doppler suggests no aortic insufficiency.  There is mild to moderate tricuspid regurgitation.  The peak tricuspid regeugitant velocity was measured at 3 meters per second, suggestion mildly increased right ventricular systolic pressure. Evidence of mild ph.  He put me on lasix and altace which increases my urination, but the edema just comes back by evening.  He wasn't concerned with PH, he said just watch it for a year.  I've heard what can happen if you delay treatment.  Suggestions?  TY

[Cleveland Clinic]

christianirc,

Thanks for the post.

Unless there was specific evidence of right ventricular dysfunction, I would have a hard time believeing that the amount of swlling you are describing is due to the mild increase in your pulmonary pressures. Overall, in someone with as significant lung disease as you, it is not all that surprising to have some elevation.

Edema can be caused by many different factors. 2 specific things specific to our histor could be water retention from your steroids or even more likely the use of the calcium channel blocker in your medical therapy.

I would look at these factors first, then follow you closely with respect to your overall cardiovascular health.

good luck

[christianirc]

Just to let you know, due to space limitation I only posted what was 'abnormal' on that echo.  Everything else said it was normal.  Here is the full text if you want it:

Findings:  The left ventricle appears to be of normal size and demonstrates preserved systolic function.  The technician-estimated ejection fraction is 54%.  The aortic and mitral valves are not well seen.  Doppler suggests no aortic stenosis.  Color flow Doppler suggests no aortic insufficiency.  The mitral valve appears to be normal, with preserved mobility.  No mitral regurgitation is seen.  Both left and right atria are of normal size.  There is mild to moderate tricuspid regurgitation.  The peak tricuspid regeugitant velocity was measured at 3 meters per second, suggestion mildly increased right ventricular systolic pressure.  The pericardium is normal.  The ascending aorta is not dilated. 1.  Preserved systolic function without left ventricular dilation. 2. No significant valvular abnormalities identified. 3. Evidence of mild pulmonary hypertension.