I am a 49 year old female with a 5 year history of shortness of breath with exercise. I have had periodic echoes because the pulmonary pressures have been between 40 and 50. Two right heart catheterizations done in 2007 and 2008 showed a mean pressure 0f 18 which is normal. Last year I had a TIA and the MRI showed 3 previous strokes.They have ruled out the cause being my heart but I had an exercise echo done and my pulmonary pressures went higher than normal.Therefore, the doc thinks its my lungs though all tests have been normal so far. My question: I have noticed the last little while that when I get up at night, I am quite short of breath. I checked my saturations before getting out of bed this morning and I was 91%. It makes me wonder what it drops to during the night while asleep. Is this normal? what do I do?
You have provided nicely detailed information. What you describe is consistent with what is called a thrombo-embolic syndrome. The evidence suggests that you have pulmonary hypertension, despite the one mean pulmonary artery (PA) pressure you cite of 18. That is an abnormal clot formation in the venous side of your circulatory system associated with the passage of clots or fragments of clots into your veins and/or arteries (The TIA and “previous strokes”)
That you do have pulmonary artery hypertension would also be consistent with the “higher than normal” PA pressure during the exercise ECHO.
I would also wonder if “the cause being my heart” has convincingly ruled out. If not you could have what is called right to left shunting (of blood) in your heart that would enable clots that were formed in your veins to pass (within the heart) into your arteries, including those that nourish the brain. Such shunts can exist, yet not be evident on a conventional ECHO, unless specifically looked-for.
That is a lot of speculation but I do believe that your problem warrants further investigation in three categories: 1) a re-assessment of the pulmonary hypertension including the question of whether it is primary (originating the blood vessels within your lungs) or secondary to clots from your peripheral veins and, 2) a detailed evaluation of the coagulation status of your blood and, 3) additional diagnostic studies to determine the source of (presumed) clots responsible for the TIA and the “3 previous strokes.”
Many academic medical centers now have Pulmonary Hypertension (PH) Clinics staffed by physicians with experience and good understanding of all the causes of pulmonary hypertension. I strongly recommend that you and your doctors arrange for consultation with such a clinic, without further delay. Yours is a very serious problem. You and your doctors should proceed without further delay, to seek a second opinion from a PH Clinic, to establish a diagnosis and initiate appropriate therapy.
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