Pulmonary Hypertension-diagnosed during pregnancy

[hannahsmama22]

I just delivered my son March 22, 2012. At 33 wks I was admitted to the hospital for a week with a suspected PE (which i've had one in 2004 caused by birth control and smoking-haven't smoked obviously or birth control since. In 2004 they ruled out any clotting disorder and said it was the smoking/birth control that caused it. My first pregnancy I delivered my daughter Mrach 21, 2011 without any problems I was on Heparin as a prophylactic due to the previous clots to be safe. I became pregnant again quickly after the 1st, they are exactly a year apart. So back to the hospital stay at 33 wks...my daughter had a case of rsv, then i became very ill very fast, horrible cough, shortness of breath (which i do have asthma but it got pretty bad)fast heart rate etc..I felt horrible. They gave me a CT scan of my lungs to determine whether I had a PE. The test came back "inconclusive" due to the tech not getting a good picture. The CT was repeated and same thing, "inconclusive". When I was admitted they performed an echo on me, and found that my pulmonary arterial pressure was at 42. They compared to a test from 2010 my pressure was only 24 back then. They treated me with a heparin drip, and a few days later repeated the CT for the 3rd time and the test came back negative, no PE. But could the few days time frame already have dissolved a clot? Anyhow, they repeated the echo a wk before delivery and my number had remained close to the same at 42. Sometimes I have a fast heart rate, and minor shortness of breath,really  fatigued (but not sure if this is just from postpartum. Now I am 4 weeks post-partum, and I just seen my internist doctor and he recommends I repeat the echo in a few wks to re-check the arterial pressure. Is it possible the numbers could have been off due to high pregnancy blood volumes? I am terrified!! I am only 29 years old and have 2 beautiful babies I don't want to leave them.I am having constant stress thinking my life expectancy will be very short now?

[Jonathan D. Rich, MD]

Hello and welcome to the forum.

First of all, congratulations on the baby (or should I say babies!).

Second, although I can not make any guarantees, I am almost CERTAIN that you do not have pulmonary hypertension...so please take a deep breath, kiss your children, and RELAX.

You are absolutely correct that the increased blood volumes during pregnancy could cause an elevation in the pressure suggested by the echo.  But even more importantly, ECHO is NOTORIOUSLY unreliable for evaluating pulmonary hypertension.  It is wrong ALL the time.   Moreover, the number 42 is barely abnormal anyways (and again, if accurate, this was during pregnancy).

What is most important is your symptoms. We do not treat "numbers" by echo.  I suspect that as you continue to get reconditioned, sleep more (as your baby sleeps more, etc) your fatigue, etc will improve.  However, if you feel fatigued and very short of breath, a general assessment of these symptoms should be performed by your doctor as it could be anythign (ie these symptoms are very nonspecific).  The fact that you have had blood clots in your lungs in the past is a notable thing and you will need to decide with your doctor if you should remain on blood thinners or not.  Regarding the CT scans, it is hard for me to comment...sounds like several poorly performed tests.  Another test that can be performed, however, is called a V/Q scan if suspicion for PE remains high.

Please look forward to a wonderful long life with you children.

All the best,

Dr. Rich

[Jonathan D. Rich, MD]

Hi.

Please read this post carefully:

1. Echo can NOT accurately or reliably diagnose pulmonary hypertension.  If you get an echo and the Right Ventricle is said to be severely enlarged and not working, that would be a helpful and important finding.  But the number that the echo tells you in terms of your pulmonary pressures is COMPLETE NONSENSE.  NO decision in terms of diagnosis or treatment should ever be made on the basis of the echo.  If any doctor tries to diagnose you or treat you on that basis, PLEASE get another doctor.

2. If you are having symptoms of fatigue, fast heart rate, etc you should get this assessed (without any reference to pulmonary hypertension).  Those symptoms could be anything at all or absolutely nothing to worry about...but you need a good, competent doctor.

3. From your post, it sounds like you live in the midwest.  If you would like to make an appointment with me, I would be happy to see you (and most likely alleviate all your concerns).  However, if Chicago is too far but you are in Michigan, the place to go regarding a pulmonary hypertension assessment is University of Michigan-Ann Arbor with Dr. Val Mclaughlin.  And if you see her, you can tell her Dr. Rich sent you.

Please take a deep breath...everything is going to be ok.  And please stay off the internet...it is driving you crazy!

Best,

Dr. Rich

[hannahsmama22]

I forgot a few more things, I also still seem to get a fast heart rate without doing much activity which started with this second pregnancy. It seemed to have improved just a little since I delivered but not by a whole lot yet. The doctors noted my above average fast heart rate during my entire pregnancy. My last echo the week before delivery shown that I not only had a high pulmonary arterial pressure, but also a heart murmur, leaky valve, and mild mitral valve regurgitation. I would have to ask for the results again to get the exact results but I think that was close to the results. I am hoping and praying all of this goes away when I have the echo repeated. Just wondering what your opinion is on the other results in conjunction with the high arterial number. Thanks so much and again sorry for the 100 questions! As you can tell I am anxiety ridden over this.

[hannahsmama22]

Thank you so much for taking the time to reply to my message. You made me feel so much better knowing there is a good chance the number will go down. When I seen my primary internal medicine doctor he seemed concerned which really frightened me and told me if I repeat my echocardiogram and the number doesn't go down he wants to send me to the University of Michigan tursurie-forgive me i don't know how to spell it haha..all I know is that information really scared me. He told me if I am diagnosed that the outcome isn't that great and there's not many treatment options.I have a couple more questions if you wouldn't mind, it's been almost 6 weeks since I delivered, how long do you suggest I wait to repeat the echo? My doc said about 8-12 weeks after pregnancy so my body has time to start returning to normal. Also, if the number is higher than 25 when I repeat it, is there a good chance I will be diagnosed with pulmonary hypertension? According to some websites I have read, they say you are usually diagnosed with it past 25...Although you made me feel a ton better with your first response, I tend to continuously scare myself pretty badly with the potential outcome of the disease. I continue to be somewhat tired, a little short of breath, chest pains here and there (which could be muscular from lifting the babies) and also have a hard time sleeping on my left side since I was admitted to the hospital at 33 wks pregnant. When I do it seems to have a weird, heavy like hearbeat. I appreciate you taking the time to help me.