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hypertension and pulmonary artery raised systolic pressure
i am 25 years old male patient diagnosed with hypertension for last 5 years predominantly with white sever white coat effect.
every year i undergo by myself some screening tests such as echoe lipid profile and kidney fuctions. all of them are perfectly normal except this time echoe shows mild tricuspid regurgitation and mildly increased pulmonary systolic pressure estimated around 40 of mmHg although as stated above all the other values are normal but i scared about this finding. is it possible to be due to a secondary reasons, i feel it is good to state it here that i have recurrent rhinorea and sneezing.
my second questions is related with the white coat effect.
when i check my blood pressure at home using an aneroid sphygmomanometer it measure my BP around 130/80 but if i use digital BP Set (currently i use omron's digital BP set) it gives variable values varying between 140/70 to 155/75 mm of Hg with my resting heart rate of 65 to 70 bpm. but as i go to clinic or lab my heart rate increases to 100 bpm and BP to 165 to 170 mm of Hg systolic and 90 mmHg diastolic. any new situation i face any stranger i talk to or communicate to, i feel the same palpitations and anxiety. what you would recommend to me?
i have a strong family background of hypertension as well and currently i dont user any pharmacologic treatment, i just do excercise running and gym and avoid excess salt. looking forward for your detailed answer. thanks in advance
every year i undergo by myself some screening tests such as echoe lipid profile and kidney fuctions. all of them are perfectly normal except this time echoe shows mild tricuspid regurgitation and mildly increased pulmonary systolic pressure estimated around 40 of mmHg although as stated above all the other values are normal but i scared about this finding. is it possible to be due to a secondary reasons, i feel it is good to state it here that i have recurrent rhinorea and sneezing.
my second questions is related with the white coat effect.
when i check my blood pressure at home using an aneroid sphygmomanometer it measure my BP around 130/80 but if i use digital BP Set (currently i use omron's digital BP set) it gives variable values varying between 140/70 to 155/75 mm of Hg with my resting heart rate of 65 to 70 bpm. but as i go to clinic or lab my heart rate increases to 100 bpm and BP to 165 to 170 mm of Hg systolic and 90 mmHg diastolic. any new situation i face any stranger i talk to or communicate to, i feel the same palpitations and anxiety. what you would recommend to me?
i have a strong family background of hypertension as well and currently i dont user any pharmacologic treatment, i just do excercise running and gym and avoid excess salt. looking forward for your detailed answer. thanks in advance
You can do a search and find many others finding isolated higher than normal pulmonary pressure readings-- many times this is a fluke in the measurement method. The measurement is taken from the tricuspid regurgitation jet (which almost everyone has as a normal variant) There are other reports of people getting readings as high as 50 mmHG and having a right-heart cath and finding normal readings of 25 mmHG. Keep in mind the upper limit of normal is 35 mmHG so the variation from normal isn't that far off-- but the estimate from echo can vary quite a bit from one reading to the next.
I think you are going to have to live with uncertainty for a while. But I do think you might feel better if you would take some active steps to control your blood pressure. That is one thing you could address. The yearly checkups are something else that you can keep doing. And then also, the mental conditioning to feel as well as you can emotionally under the circumstances is another thing. You're not helpless, because there are, in fact, things that you can do to help yourself. It just doesn't look like you are necessarily going to get "the one big answer" right now that you are looking for. But you can live with that.
thanks i got your point
my problem, basically, is related to health related and i always feel that i am weak and ill. i dont know why my anxiety get to the peak and then get reduce only when i do any lab test for that condition. for e.g when i feel that my heart is weak then i only get satisfied when i do an echoe and it shows normal values or when i feel myself as anemic and get anxious then only that time i feel better when my CBC reports are normal.
thanks again
my problem, basically, is related to health related and i always feel that i am weak and ill. i dont know why my anxiety get to the peak and then get reduce only when i do any lab test for that condition. for e.g when i feel that my heart is weak then i only get satisfied when i do an echoe and it shows normal values or when i feel myself as anemic and get anxious then only that time i feel better when my CBC reports are normal.
thanks again
Cognitive therapy consists of examining your thoughts to become aware of what it is you tell yourself that is actually making you anxious. It's not the situation that makes you anxious, it's what you think about it. The therapy helps you realize what your anxiety-generating thoughts are and helps you learn how to change those thoughts to self-soothing thoughts. There is a book called Mind Over Mood that is good, but it is even better to have a therapist as your coach. The book will give you the basic concepts, but using a book for cognitive therapy is kind of like using a book to learn how to play tennis or play the piano. Theoretically, you could use a book to learn how to do those things, but in actual practice, most people need a teacher to help them.
thank you so much for your detailed insight into my problem, now i really feel that i would be able to do care of my heart better than i did previouse.
secondly anxiety is my main problem. i always think very bad about small things e.g when i see a small pimple on my skin i think that it could be neoplastic and always remain anxious till it get disappear. this was a real example other conditions, i hope, you can assume better with this example.
please share with me experience or knowledge about this problem
thanks in advance
secondly anxiety is my main problem. i always think very bad about small things e.g when i see a small pimple on my skin i think that it could be neoplastic and always remain anxious till it get disappear. this was a real example other conditions, i hope, you can assume better with this example.
please share with me experience or knowledge about this problem
thanks in advance
For the anxiety, I recommend cognitive therapy, and I can post more detail about that, if you're interested. Anxiety can be managed and controlled.
Thanks for your own detailed response. Okay, first of all, I can't really counsel you, because I'm not a doctor. This is the "community" forum, which is composed mostly of patients. People here who have similar conditions volunteer to try to help their peers. Occasionally, one of the Cleveland Clinic doctors will post, but that's not really usual. There is an Expert forum on this same site (click Experts in the blue bar at the top of this page to access it), and that is where the doctors do most of their posting. I invite you to post on the Expert forum, also.
I myself have had surgery to replace a bicuspid aortic valve and to repair a thoracic aneurysm. Very often, a bicuspid aortic valve, when present, will present in a fashion similar to your own situation, in which hypertension is the first sign, and an initial echocardiogram will look normal. Over time, a bicuspid aortic valve will tend to deteriorate, and eventually, the aortic valve will show an abnormal appearance on a subsequent echo.
Bicuspid aortic valves tend to run in families, and in those same families you will also see, oftentimes, the other conditions that I mentioned -- sudden cardiac death (meaning cardiac death that is unexpected and at a young or relatively young age), aortic aneurysms (and sometimes brain aneurysms), and congenital heart defect (although it is usually coarctation of the aorta and not usually VSD). You don't really have the family history of someone who has a bicuspid aortic valve, and in your case it is the tricuspid valve, not the aortic valve, that is showing up with an issue.
Your tricuspid regurgitation is mild, which means that you could be seeing the first sign of a degenerative valve disease in which the regurgitation will get worse -- or it could just as easily mean nothing of the sort. It could simply mean that you got a better echo technician this time or a more detail-oriented doctor to read the echo. I think trace regurgitation and mild regurgitation are common in the general population. Many people probably have a heart valve that leaks slightly, and they never know about it, because it doesn't cause them any problems. But I think you need to keep an eye on the tricuspid valve, to make sure it doesn't get any worse. I also think you need periodic echoes to make sure your hypertension isn't damaging your heart.
Because it's a bit of a mystery as to why a healthy, active 20 year-old would develop hypertension, and because it's perhaps even more of a mystery as to what, if anything, the new finding of mild tricuspid regurgitation means, I do think you need to continue to be followed medically. When you say that every year, by yourself, you undergo some screening tests, I hope you mean that you have a cardiologist who you see once a year who is ordering those tests. Continuity of care is going to be very important. It will be better for you to see the same doctor every year than to find a random doctor once a year to order the tests. You need a doctor whose curiosity is aroused, who wants to help you solve the mystery. It might take a long time, before you have a clear picture of what is going on with your heart. In the meantime, the best advice I can give you, as your peer, is to keep up with your medical check-ups and to control your blood pressure.
I myself have had surgery to replace a bicuspid aortic valve and to repair a thoracic aneurysm. Very often, a bicuspid aortic valve, when present, will present in a fashion similar to your own situation, in which hypertension is the first sign, and an initial echocardiogram will look normal. Over time, a bicuspid aortic valve will tend to deteriorate, and eventually, the aortic valve will show an abnormal appearance on a subsequent echo.
Bicuspid aortic valves tend to run in families, and in those same families you will also see, oftentimes, the other conditions that I mentioned -- sudden cardiac death (meaning cardiac death that is unexpected and at a young or relatively young age), aortic aneurysms (and sometimes brain aneurysms), and congenital heart defect (although it is usually coarctation of the aorta and not usually VSD). You don't really have the family history of someone who has a bicuspid aortic valve, and in your case it is the tricuspid valve, not the aortic valve, that is showing up with an issue.
Your tricuspid regurgitation is mild, which means that you could be seeing the first sign of a degenerative valve disease in which the regurgitation will get worse -- or it could just as easily mean nothing of the sort. It could simply mean that you got a better echo technician this time or a more detail-oriented doctor to read the echo. I think trace regurgitation and mild regurgitation are common in the general population. Many people probably have a heart valve that leaks slightly, and they never know about it, because it doesn't cause them any problems. But I think you need to keep an eye on the tricuspid valve, to make sure it doesn't get any worse. I also think you need periodic echoes to make sure your hypertension isn't damaging your heart.
Because it's a bit of a mystery as to why a healthy, active 20 year-old would develop hypertension, and because it's perhaps even more of a mystery as to what, if anything, the new finding of mild tricuspid regurgitation means, I do think you need to continue to be followed medically. When you say that every year, by yourself, you undergo some screening tests, I hope you mean that you have a cardiologist who you see once a year who is ordering those tests. Continuity of care is going to be very important. It will be better for you to see the same doctor every year than to find a random doctor once a year to order the tests. You need a doctor whose curiosity is aroused, who wants to help you solve the mystery. It might take a long time, before you have a clear picture of what is going on with your heart. In the meantime, the best advice I can give you, as your peer, is to keep up with your medical check-ups and to control your blood pressure.
thanks for your detailed response.
as you rightly assumed that i am not obese my body weight is 72 and my height is 176 cm.
secondly as i have mentioned that i have strong family background of hypertension. my grand mother died of stroke at age of 85 years, my grand father died of same reason at age more than 80 years, my aunt died of heart failure and ishemic heart disease at age of around 60 years, my cousin have interventricular septal defect which is perimembranous but very minute 2 mm in diameter.
my mother is hypertensive and taking ARBs as pharmacological therapy.
i myself had no heart disease at my early age or childhood.
my problem is that i most of the time feel some panics about my heart and conditions.
even i can run with a moderate speed for more than 30 minutes and daily i do exercise for about 1 hour.
all the secondary reasons i have rule out for hypertension i.e pheochromocytoma thyrotoxicosis, renal artery stenosis and aortic coarctation.
please council me regarding my cardiovascular conditions
thanks in advance
as you rightly assumed that i am not obese my body weight is 72 and my height is 176 cm.
secondly as i have mentioned that i have strong family background of hypertension. my grand mother died of stroke at age of 85 years, my grand father died of same reason at age more than 80 years, my aunt died of heart failure and ishemic heart disease at age of around 60 years, my cousin have interventricular septal defect which is perimembranous but very minute 2 mm in diameter.
my mother is hypertensive and taking ARBs as pharmacological therapy.
i myself had no heart disease at my early age or childhood.
my problem is that i most of the time feel some panics about my heart and conditions.
even i can run with a moderate speed for more than 30 minutes and daily i do exercise for about 1 hour.
all the secondary reasons i have rule out for hypertension i.e pheochromocytoma thyrotoxicosis, renal artery stenosis and aortic coarctation.
please council me regarding my cardiovascular conditions
thanks in advance
FWIW, I have two thoughts about your situation. One is that you should keep up your yearly checkups, including the echocardiogram, because something seems to be emerging that you need to keep track of. Eventually, it will become more clear what is going on, but you will have to continue to monitor the situation, in order to catch whatever the problem is in time to get optimal treatment.
My other thought is that you should consider going ahead and getting on medication for blood pressure. Even 130/80 is higher than expected for a young man who exercises and avoids salt. (I assume you are not obese, since you don't mention weight as an issue.) If your pulse rate and blood pressure are jumping up as much as you describe in a "white coat" situation, then the same thing is probably happening in other situations of transitory stress.
Okay, a third thought. Please try to be as calm and peaceful about your health and your life as you can, because there's nothing more you can do about the problem than what you are already doing, and worrying will only make you feel bad. Worrying will tend to elevate your blood pressure, too.
Let me ask you a few questions, if you don't mind. Is there any family history, even in the extended family, of any of the following? Valvular heart disease, sudden cardiac death, aortic aneurysm, or congenital heart defect? Even aunts, uncles, great aunts and uncles, grandparents, great-grandparents, cousins, and distant (2nd, 3rd etc.) cousins are relevant. Or did you yourself, perhaps, have any kind of heart problem at birth that was successfully treated or that resolved on its own?
My other thought is that you should consider going ahead and getting on medication for blood pressure. Even 130/80 is higher than expected for a young man who exercises and avoids salt. (I assume you are not obese, since you don't mention weight as an issue.) If your pulse rate and blood pressure are jumping up as much as you describe in a "white coat" situation, then the same thing is probably happening in other situations of transitory stress.
Okay, a third thought. Please try to be as calm and peaceful about your health and your life as you can, because there's nothing more you can do about the problem than what you are already doing, and worrying will only make you feel bad. Worrying will tend to elevate your blood pressure, too.
Let me ask you a few questions, if you don't mind. Is there any family history, even in the extended family, of any of the following? Valvular heart disease, sudden cardiac death, aortic aneurysm, or congenital heart defect? Even aunts, uncles, great aunts and uncles, grandparents, great-grandparents, cousins, and distant (2nd, 3rd etc.) cousins are relevant. Or did you yourself, perhaps, have any kind of heart problem at birth that was successfully treated or that resolved on its own?
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