RVSP @ 30mm hg w/ IVC fail to collapse

[edprof]

59 M, with Ascending A. Anuerysm (4.1). No changes 2 yrs. 2yrs of ECHOs--valves normal, mildly dilated LA and LV, Normal RA & RV. No Pulmonary Hypertension ever noted?
Jan '08 Echo results indicate enlarged heart from last ECHO of 6 mos ago.  My results:
---no change in Anuerysm
---Mild Concentri LV Hypertrophy
---NormalLV systolic function
---EF= 55-60
---LA mildly dilated
---RV moderately dilated
---TraceTricus regurt
---RA moderately dilated
---RVSP est @ 30-35, IVC is plethoric and fails to collapse with respiration---suggests high RA     pressure--RA pressure= 15 mmg, TR peak Velocity @ 200 cm/sec
--possible PFO or small ASD by color
---Mitral valve normal---Mild Mitral regurt observed
---no aortic valve regurt
---no pericardial effussion
Questions--
1.  All this happened in less than 6 mos,  should i be rushing to the CC?
2.  What could be the causes of this change?  Diagnosis?
3.  Am i at risk of a sudden cardiac event?
4.  Are these type of enlargments reversible?
5.  Does the possible PFO or ASD have something to do with this---can they be repaired?
Note:  I jog 4 miles daily, BP:105/65, Choesterol: 121
          MEDS: Atenolol, Vytroin, Atacand

thank you

[Michael J. McWilliams, M.D.]

1.  All this happened in less than 6 mos,  should i be rushing to the CC?  
2.  What could be the causes of this change?  Diagnosis?
5.  Does the possible PFO or ASD have something to do with this---can they be repaired?


I will answer the first two questons as one.  This is where you would pull up the previous two echo's and make sure the changes are real.  If they are, this is not the end of the world.  It sounds like your right sided heart is showing the most changes -- increased pulmonary pressure, dilated RV. It sounds like a volume overload issue and begs the question of whether or not you have a small hole in your heart and is it allowing blood to flow from the left side of your heart to the right --- this would be the question PFO/small asd comment.

It might be worth doing a TEE to further define this question.  A TEE is a transesophageal echo ( an echocardiogram from inside your throat).

It is worth seeing a cardiac specialist to answer these questions.  The more difficult questions is if there is a whole allowing volume overload of the right heart, would you benefit from a closure.  Many private practices and academic centers can help you answer this question.

You sound like you are relatively asymptomatic so your symptoms cannot be improved.  A closure procedure may stop the progression of the enlarging right ventricle and increased pulmonary pressures (if this is the cause).




3.  Am i at risk of a sudden cardiac event?

None of the features you mentioned above suggest that you are at a significant increased risk of sudden death.

4.  Are these type of enlargments reversible?

Probably not, but if there is a hole, closing it will prevent further progression.  The bigger long term risk is developing atrial arrhythmias like atrial fibrillation or flutter.  Again, not life threatening but may cause symptoms and does increase your risk of stroke.

I would recommend seeing a specialist, it does not have to be the Cleveland Clinic but they are always welcoming to new patients. A local academic center or very good private practice group will probably do.

Where do you live?

[Michael J. McWilliams, M.D.]

if you RVSP is 30 and estimated atrial pressure is 15, you have mild pulm hypertension.

shouldn't be a problem to job but that is really a questions for some that has seen you studies.

again, would need  to see the studies and it would also depend on if there is a pfo/asd and if your heart condition pregressed.  that is why i think you  need to see a specialist.  There are tons of good doctors in new york, as you know.  I trained at the Cleveland Clinic with nicholas dubois -- he is a cardiologist in Manhatten and Nitin Barman at Sinai.  If you need a second opinion, I know they are well trained and very intelligent.

I hope this helps.

[edprof]

Thank you for you help and I appreciate our quick response.  I do feel a bit relieved since I have not been able to meet with my MD here---still on holiday.   I live in Long Island, NY. These last results were a shocker to me.  No family heart disease, both parents lived to early 90's, older brothers are in good health and I am competely asymptomatic-- I feel great.  A question or two--
1---are these results consistent wiht pulmonary hypertension?
2---should i still keep up with my jogging?
3---does this type of condition, once stablelized affect longevity or what would be my normal life span---I always thought i would make it to my late 80's etc---unless i get hit by a train or something!
Thank you again