So much confusion....about pulmonary pressures

[C.N.]

I have posted a question before on this subject but I'm still very confused.  I am a 32 year old woman.  I've had a pacemaker for one year (sick sinus syndrome).  Before my pacer was placed I had P.A.P. pressures in the forties.  Now my pressures are more elevated, not much.  My doctor says they are elevated due to tricuspid regurg. from the pacer leads.  I also have various rhythm problems including A-Fib with rapid ventricular responce and pacemaker mediated tach. which they can't get rid of.  I'm on Tambocor, coumadin, lopressor and verapamil.  I also have had alot of symptoms,including shortness of breath, trouble laying down (can't breath, head pressure)and occasional swelling in ankles.
     Alot of this is not making sense to me.  I don't want to run out and get a second opinion from a PH specialist if it's not necessary, but I feel I need some clarification.  I do understand that a right heart cath. is necessary to get a proper diagnosis.  My doc. says no, because it will disrupt the pacer leads.
     What I'm wondering is:
1)Doesn't P.H. need to be treated at an early stage, so it doesn't progress, or if there is a secondary cause should'nt that be addressed?  In my case how can this be done?  Should it be done?

2)Another big confusion I'm having is the conflicting info. I have heard about pulmonary hypertension.  In all of the literature about P.H. it talks about it being a devastating illness that should be treated sooner rather than later.  At other times I've heard people say that their doc. doesn't think it's important, or that nothing should or can be done.  Some advice completely conflicts with others, what am I missing?  In other words is PH always a big deal or in some cases no?

3)In my case what do you think should be done?  and how could my pressures be elevated before the pacemaker if the pacer is the supposed reason for the PH?  Willit progress?

I know this is long, I'm sorry.  I have very high regard for the opinion of the doctors from the Cleveland Clinic and I know there are specialists there for PH.  Thank you so much ahead of time for clearing up this confusion for me.

[Cleveland Clinic, MD]

Dear CN,
It's normal to have some confusion about pulmonary hypertension and even some doctors do not completely understand it.  First let me say that it is never wrong or a bad idea to get a second opinion from someone with expertise in that area.  Doctors don't know everything about every area and we ourselves encourage getting a second opinion if we are unsure about something.
That being said it may be ok for you to wait.  There is a differece between the disease of pulmonary hypertension and mildly elevated pulmonary artery pressures.  Mildly elevated pulmonary pressures are common and are not cause for concern.  Pulmonary hypertension is a devastating disease that is very difficult to treat.  It is true that for reversible causes of PH the sooner it is treated the better but for primary PH the need for early diagnosis is not as critical.  I hope this helps clarify things for you.