elevated pressures from echo - PH?

[p1954]

from recent 2D echo:

mitral Doppler consistent with grade 2 diastolic dysfunction.   tissue relaxation velocity abnormal
tricuspid valve Doppler indicated right heart calculated pressure of 55 mm (per Dr markedly abnormal for a 59 yo man)
mean calculated pulmonary artery pressure of 30 mm consistent with moderate pulmonary hypertension
left atrium and ventricle are mildly dilated without hypertrophy
aortic vale is normal
right ventricle cavity is normal in size and function

My intern thinks I should have a cath to assess  as he suspects the calculated values are misleading - He says I wouldn't be as active as I am if these pressure were correct.   I have no apparent outward symptoms and cana briskly walk a mile or 2 with no problem.  

would you agree I have PH, or do you agree with the internist that a cath is warranted to get a truer picture?

thanks

[Jonathan D. Rich, MD]

Hello and welcome to the forum:

To me, your echo is consistent with someone who may have or had high blood pressure or being overweight at some point in your life.  To truly determine whether you have "PH" as a result of this would need to be determined by RHC.

However, I completely disagree with the internist about the interpretation of severity (nothing sounded severe about it to me) or how you should feel (I'm not surprised you feel fine).

I would suggest an appt with a competent cardiologist. The two of you could discuss whether a RHC would be indicated and the pros/cons.  But I would focus on BP control, weight loss, stopping any other bad habits (smoking, alcohol), possibly being tested for sleep apnea and getting this treated if you have it, etc.  Long and short of it is that you do not have the type of PH that requires PH-specific drugs.  You may have mild PH as a consequence of other things---and the treatment of that is the "other thing".

Good luck.

Dr. Rich

[Jonathan D. Rich, MD]

I agree with you that the most likely explanation of the "PH" is related to your mild LV dysfunction including diastolic dysfunction.  The focus should be on the LV and not the PH.  But, if too much confusion remains and your docs are insistent, a right heart cath is very safe.

Best of luck.

Dr. Rich

[p1954]

thank you Dr Rich

and sorry, I left some important information out.

I failed to mention the echo comments were from my cardiologist report which was then discussed with my internist.   This is second echo after a cardiac event which compromised my left ventricle late 2012.    
Current LVEF is 45 to 50%.   Mild LV systolic dysfunction.  some stiffing in LV.  
What bothered me was that PH in conjunction with diastolic dysfunction were new descriptions and seemed to point to a decline and ultimately poor outlook when I read the cardiac information from a couple of university medical centers.  So I asked my internist his opinion.   That's when he suggested the RHC.  I am disappointed that my cardiologist, who has been great until now, did not mention the PH+DD and the implications and I did not learn this until I read the echo when I got home.  But my cardiologist did prescribe Losartan.   I have never been overweight or had chronic high blood pressure.   Was thinking that the heart diastolic dysfunction brought on the PH some time over the last year.