It is possible to have an increase in the systolic pulmonary pressure in the span of 4 years. In just 4 months it is possible for this pressure to increase from 30 to 43. This can happen with or without shortness of breath. The pressure measurements are quite accurate with an echo. Cardiac catheterization is the "Gold Standard" for the exact measurement of pulmonary arterial pressure.
To have your questions about the vena cava answered by the cardiologists at the Cleveland Clinic Heart Center, please submit them to the Heart Forum at http://www.MedHelp.org