elev. pulmonary pressure

[jan]

Hello Dr.,

I am f, 5'5" and 125lb, and soon to be 47. I am in good health considering many diagnoses.

I have had a little more than a few echoes.  I was diag with mild mvp, mild mr, and mild tr.  This last echo took place in the hospital this year and had an added element. It said mildly elevated pulmonary pressure.
(I was admitted to hosp with L. shoulder and arm pain, and a coincidentally abnorm ekg. It turned out to be c-spine pain.)
  
The cardio asked if I smoked, had asthma, pneumonia at any time, or severe case of bronchitis.  The answer is "no" to all.  Both my parents had emphysema late in life, neither smoked.  Mom did have chronic bronchitis and later asthma, pneumonia a number of times. (Mom had 2 bypasses and a MVR and died of CHF).  Dad worked with chemicals for printed circuitry, don't know if that means anything.  We lived in front of a furniture factory that left paint all over surfaces in our yard and in the kitchen window.  I gave that history to explain possiblities for the emphysema, because I wonder if it may be related to something here.

Are there any further tests I should have for the PP?  Or just wait for a symptom or a few years for another test?

Thank you.

[CCF-M.D.-RCJ]

Jan,

Thanks for the post.

CN gave you good advice.  Pulmonary pressures frequently rise and fall depending on "loading" conditions, which can be affected by hydration status, hypertension (especially in the presence of mitral regurgitation), anxiety, and the quality of the echo (and reader).  

The only real concern that is raised by the mild pulmonary hypertension is whether or not your MR is being underdiagnosed.  Significant MR is a frequent cause of elevated pulmonary pressures, and so must be looked for in someone with "mild" MR and elevated pulmonary pressures.  Alternatively, and probably most likely, the pulmonary hypertension was over-called.  Either way, a repeat echo at your local center, or at a large center, should help elucidate the problem.

Hope that helps.

[jan]

I am on atenolol and verapamil for NCS and IST.  Other meds for other conditions.  Also, on aspirin therapy, prescribed by cardio for Factor V Leiden.

[Lyn2]

Jan,
Do you know what your pulmonary pressures were.  It may be helpful for the doc. to know.  I went through the same thing.  I had mild pulmonary hypertension on echo.  edema, heart arrythmias, and they finally decided to do a right heart cath. (the gold standard for diagnosing pulmonary hypertension).  Sometimes the echos. are not accurate.  I ended up having normal pressures with the heart catheterization.  Good luck!

[jan]

Thank you dr. and cn,

I don't know the numbers.  A few months before I was in the hospital for the 3 day cardiac workup I had a TEE.  My MR is mild.  So, I guess I'll just relax.  :o)

[nurse12hr]

I hope you are still around to read this.  There is a genetic problem that can cause emphysema in non smokers.  I will quote a passage and at the end I will give the link.  It is rare, but worth looking into.  

"Alpha-1-antitrypsin protects the delicate tissues of the lungs by binding to neutrophil elastase, a protein released by white blood cells which digests bacteria and other foreign objects in the lungs. When a person who is deficient of Alpha-1-antitrypsin inhales irritants, or contracts a lung infection, the neutrophil elastase released in the lungs continues digesting irritants unchecked, eventually destroying healthy lung tissue. The eventual result of the destruction of healthy lung tissue by neutrophil elastase is emphysema.

However, alpha-1-antitrypsin deficiency emphysema (also known as "Genetic" or "Inherited" Emphysema) is different than emphysema caused by smoking ("acquired" emphysema). In emphysema caused by smoking the damage usually affects the upper portion of the lungs. In the Alpha-1 patient, the lower regions of the lungs are first affected. With either cause, the lungs are hyperinflated due to air trapping caused by the destruction of the lung tissue, and the diaphragms are flattened due to the hyperinflation of the lungs.

Many people with Alpha-1 also have chronic bronchitis. With this, the lung lining becomes swollen and congested with mucus, restricting air flow. The bronchi (air passages) often go into bronchospasms, which are contractions of the muscles which further reduce air flow. This often results in a chronic cough.

Asthma is common in patients with Alpha-1. It is characterized by wheezing, coughing, and shortness of breath. Asthma is often precipitated by allergens, stress, exercise, and infections. In Alpha-1 patients, symptoms of asthma can be managed with medications."

http://www.alpha1.org/what/geninfo_faq.htm#lung

http://ghr.nlm.nih.gov/ghr/disease/alpha1antitrypsindeficiency

http://www.alphaone.org/

[jan]

Thank you for the info.  I just had an appt with a primary as a new patient and we discussed this.  Unfortunately, there was so much to talk about for a first visit and with all the diagnoses I have.  He did mention the test and then we talked about how we could rule it out as environmental.  We both forgot about the test by the end of the appt.  LOL  I asked sis to get it, because of her asthma, though.  I hope she will and I will ask about the test again at my next appt.  
Thank you for your kindness in posting the info and links. :o)