Pulmonic Insufficiency

age: 65 very active male, factor V Leiden, Prot S and C deficiency (Lovenox)
1. Early years Phlebitis L-LE
2. MI 1980 age 37
3. DVT R-LE post foot fracture
4. Bleeding ulcers and artery perf 1998, subseq pyloroplasty
5. Multiple centrum semiovale infarcts over years prior to knowledge of coagulopathy issues
6. lacunar infarcts both temporal lobes
7. Periventricular white matter disease
Now - Progressive shortness of breadth after strenuous gym workout or even worse when walking up stairs(14).
recently have had pulmonary stress test -normal, cardiac stress test- normal. CT angiography shows 'possible'   old
LAD thrombus (maybe) but recanalized. LVEF of 42%. Echocardiography shows LVEF of 40% but in two instances
two echos have shown moderate+ pulmonic insufficiency, right ventricular enlargement (not severe).

Could this be the source of shortness of breath? There is also note that in either case the pulmonic valve is very poorly visualized.

[Douglas Bogart, MD]

It is unlikely that the pulmonary insufficiency (PI) is causing the shortness of breath.  However the PI could be a marker of pulmonary hypertension (PH) possibly from prior pulmonary emboli.  PH could be due to the reduction in ejection fraction (42%) and this could cause shortness of breath.