PH, CGH or insignificant?

[sonja825]

Many symptoms treated 10 yrs. Acutely ill 01/06.  2 mo antibiotics home; a wk in hospital 03/06, pneumonia; dehydration. Echo SOB. Told Echo showed nothing significant.SOB continued spradically since; frequent since 01/08 at rest, w/minor activity  25 lbs 2 mo, largely upper abdomen. 48 WF, 5'2", 138 lbs. 113 lbs late 12/06. Swelling feet, ankles, hands, abdomen. Heart "flutterings" several yrs; tachycardia didn't warrant treatment. Ultrasound last wk rulled out PE's.

Echo report '06 states "Conclusion: Mild pulmnonary hypertension.(1)...LV normal wall thickness, end-diastolic volume. Regional and global LV systolic performance normal to hyperdynamic. LV filling pattern suggest impaired relaxation. ..probably due to rapid heart rate present during study. .confirmed by normal tissue Doppler interrogation of mitral annulus velocity. RV normal size, performance (2) atrial chamber dimensions normal (3) valves normal structure. Tricuspid regurgitation the peak velocity of which corresponds to pulmonary artery systolic pressure in low 40's".

Diagnosed MS 07/30/07. Began wkly Avonex therapy 09/07. Neuro prescribed Amitriptyline 25 migraines, Provigil 200 fatigue, Zyrtec10 site reaction, Neurocardiogenic syncope '06 (on table16 min b/f passing out) Toprol XL 25, Florinef .01 mg. Synthroid since age 16; now 75 mg. Tricor 145 ;Simvastatin 20. GastroE Amitiza 2/day, Lactulose. PCP Wellbutrin 200SR 2/day, Clonapin 1 mg/night. New PCP found B12, Vit D deficient '07. Started more; now  Vit D 50,000/2wks, B12 inject/3 wks.

Please explain Echo.  PH or insignificant? All symptoms related to MS or different heart problem?  Appreciate your advice.

sonja825

[kenkeith]

LV filling pattern is compromised by rapid heart rate.  Significance less blood pumped into circulation with each stroke causing a faster heart rate to meet demand...Filling phase of LV's functionality is not due to thickening and stiff heart walls.  Dimensions of heart walls are normal as well as valves are structionally normal.

Tricuspid pulmonary valve regurgitation can be a problem.  When properly funcitioning the valve supports pressure in the pulmonary vessel between heart beats.  Regurgitation decreases the pressures during diastolic and can cause blood to backup in the extremities and fluids leak into the tissues.

I can't see the pathogenesis of MS in any way connected to valvular insufficiency.  Shortness of breath can be heart related.  Your medical condition is very complex and is complicated by the interaction of all the medication prescribed.