Top normal inferior vena cava, right atrium, pulmonary artery pressure

[Ch]

Dear Doctors,

I've written to you previously regarding strange seemingly unrelated systems and suspected but ruled out endocarditis, followed by echoes indicating "mild" increase in LV size that appears to have stabilized and continuing enlargement of my right atrium, now at 47-50mm.  Echoes have also indicated a top normal inferior vena cava (1.95 cm), slightly high pulmonary artery pressure (I believe 37 mm/Hg), and mild triscupid valve regurgitation (1+).  My liver is also at the top limit of normal, and both kidneys are "prominent."  My recent symptoms include lower back pain, and transient periods of shortness of breath.  These periods come on rather suddenly, last for a couple of days, become less severe over those days, and are accompanied by mild pleuretic pain, and periods of lots of what I think are pvcs.

I understand that the echo results are close to or within the limits of normal.  My concern is with what appears to be a consistent increasing trend in my right atrium size, stabilized enlargement of my LV, and possible enlargment of my liver and kidneys.  No one seems to be able to relate any of my symptoms or find a cause for the enlargement (tests recommended on my last posting have not been conducted).  Can you please tell me the normal ranges for heart chamber sizes, IVC, and pulmonary artery pressure and what kind of error is expected in these measurements? Also, does anything that I have indicated in this or previous posts suggest additional tests and do you have any thoughts at all on what might be causing my symptoms?  

As always, thank you for your time.

Ch

[Ch]

Thank you for your response.  You have encouraged me to seek a second opinion.  My cardiologist has told me that he doesn't see a problem, that my measurements are within the "error band," and to return in a year, despite my complaints.  Hence, my question in my posting on how much can be written off to measurement error.  

Ch

[Ch]

The pulmonary artery pressure I referred to is the systolic pressure, not the average.

[CCF-M.D.-KE]

Dear Ch,

Sorry to hear about your symptoms and the abnormalities found on your echocardiogram. You have been experiencing SOB, back pain, and pleuritic pain. There also appears to be right atrial enlargement and mild pulmonary hypertension. It is possible that the right atrial enlargement is a manifestation of the pulmonary hypertension.  I think it would be a good idea for you to see a cardiologist who can try to put everything together for you in a unified manner. Unfortunately, without examining you or  reviewing your tests it is difficult make any definite conclusions. A reasonable first approach would be to figure out whether or not you have pulmonary hypertension, and if so what is the cause?

There are a number of conditions which may cause the symptoms you are describing. However, a very common cause would be pulmonary emboli, which are blood clots that originate in the legs and travel to the pulmonary artery.  You should make an appointment with a doctor you feel comfortable with and he or she should try to systematically figure out the cause of your symptoms and physical findings. Hope things improve.


Thanks for your question,


CCF-MD-KE