LV Hypertrophy & Diastolic Dysfunction

[Lad50]

I am a 49 y/o female with 'hard to manage' htn & unstable angina since 2002. I have been an avid walker, then suddenly this Oct. it was like my lungs were filled with cement and dyspnea grew worse coming on with exertion, to presenting with rest.

This Oct. I went through a chemical induced stress test, it took a dose of atropine to get my heart rate past 100 and up to 120, at which point PACs became an issue and the test was shut down.
A left cardiac cath was done in Nov. Findings were bradycardia and a mild enlarged ascending thoracic aorta. I was taken off 100 mg daily Toprol XL and remained on 20 mg daily Zestril, 325 mg aspirin and 60 mg daily of Imdur.
An echocardiogram was ordered to r/o pulmonary htn.
The findings per the report are:
-Concentric Left Ventricular Hypertrophy w/ interventricular septum at 1.6cm and the LV free walls at 1.4cm
-Diastolic Dysfunction of the Left Ventricle
-Trace Mitral Valve Insufficiency
-Trace Tricuspid Insufficiency w/ peak velocity across the tricuspid valve 1.7 m/sec suggesting a  
pulmonary artery systolic pressure of approx. 20 mmHG
- Estimated LV Ejection Fraction 65%
This Wed, I had to go in to the ER with dyspnea and chest pain. My blood pressure was 174/108, went down to 166/102 then back up when a nitro patch was put in place. I had a great deal of pressure in my neck
My cardiac enzymes; normal.The attending reviewed the above findings from the testing done in Oct, Nov and Dec. 5 and told me my BP was normal. The doctor did not even have a stethescope with him and never physically examined me. He did look at the monitor. I suppose he treated the monitor and old test results and not me the patient.
My concern is that my condition is not getting any better...I won't take my Bp..I know it has skyrocketed.  I have severe chest pain with exertion...the dyspnea is worsening, I am physically exhausted  

Must I just 'tip' over before something is done, are these test results normal?

[Lad50]

Dear Dr. Conaway,

Thank you so much for your response and information, all is so greatly appreciated. As you can see, I have not tipped over! I will be following up with my doctors very soon as the holidays end.

I did want to ask one more question....should I consider requesting a right side cardiac catherization as the one in Nov was left side? My cardiologist did mention ( a month ago) that pulmonary function tests might be considered by my internist.

All of my lab results (thyroid, cholesterol,ect) have been normal, I am told.

Have a safe and happy New year!

[Darcy Green Conaway, MD]

It is very common for people with very high blood pressure to get chest pain; a thickened heart muscle can make this worse. Your echo suggests your left heart pumps normally. With blood pressure that has been long-standing enough for you to develop a thick heart muscle, you certainly should be thoroughly evaluated for underlying coronary disease (blockages of the arteries) as hypertension (high blood pressure) is one of the major risk factors for that. Your dyspnea may be due to high blood pressure, but could also be coronary disease, or even pulmonary disease.