Chest pain and SOB

[MBT]

Diagnosed last year with: #1 Exercise Induced PH #2 High BP.
BP is stable, but continueing SOB, chest pain, fatigue, lightheaded, nausea, etc.

Please could you explain the following so that I can understand this completely:

Stress Test on Supine bike for 6.06 mins to max 75 W. Achieved 5.8 METS. Ended due to fatigue.

Baseline ECG sinus rhythm with non-specific ST-T abnormalities.

With stress, ECG dem. <1mm J-point with rapidly upsloping S-T segments in infero-lateral lead(s). Returned to baseline in recovery. Neg. for ischemia.

REST IMAGES: Normal left vent. chamber size. Normal global left vent. wall thickness. Normal left vent. systolic function. No regional wall motion abnormalities. Normal right vent. size & function. Est. right vent. systolic pressure: 32mmHg, increasing to 60mmHg at peak exercise. BP158/90 inc to 184/82. Normal sized atria. Left atrial vol.index 14cc/m2. Aortic valve sclerosis without stenosis or regurgitation. Mitral valve sclerosis without stenosis. Mild mitral valve regurg. Mild-moderate tricuspid valve regurgitation. Eccentric tricuspid valve regurgitant jet. No pericardial effusion.

STRESS IMAGES: Ejection fraction response to stress from 65% at rest to 75% at peak stress. Left ventricular end-systolic volume decreased with stress. There was an exercise-induced increase in the tricuspid regurgitant peak velocity, from 2.6 to 3.7 m/s (RV systolic pressure: 32mmHg to 60mmHg, assuming RA pressure of 5mmHg).

Please also explain: Left Atrium 2D Volume Index by A-L method (cc/m2) Result: 14  Normal 16-28.

Thank you.

Mary

[MBT]

C,

I saw a PH specialist last year, in May. That specialist seemed to think that the lowering of my BP would improve my exercise induced PH. My BP, with the addition of 1/2 a diuretic at the end of December last year, brought it within normal levels.

I have not had another six minute walk or anything like that to see how I am progressing with the Exercise Induced PH, though I don't have the energy to do the exercise I used to, etc. I have been under the care of a cardiologist (though he is three hours drive from where I live).

I am taking the advice of the specialist at the PH clinic I visited last year, and that was to repeat the echocardiogram in a year. Then I hope to find a PH Specialist/center involved in the treatment of Exercise Induced PH.

When it comes to Exercise Induced PH, however, this is what I recently read in a magazine. In this magazine, there was an article written by a PH specialist, and a reply in letters to the editor.  This is a quote from a portion of that reply:  'exercise induced PH may not represent early disease, rather it represents a 'different' disease that may never progress, much in the way that patients who demonstrate significant acute vasoreactivity are different from those who do not. There is no data to support the use of any PAH-specicfic therapy in these patients'. Time will tell, but it's all very confusing.

M

[Carolina03]

Mary,

I am not a doctor and cannot speak to your echo results, (although they sound great).

You said you were diagnosed with PH. My only comment is that I hope you're seeking care from a good PH specialist.

Regards,
C

[MBT]

My medication is:

A.M.
Diltiazem HCL 120mg SA(CD) x 1
Triamterene/JTCZ 37.5/25 x

[CCF-M.D.-MJM]

Hi Mary,

Sorry to hear about your diagnosis and symptoms.  I understand that you are confused by the rport but don't get lost in the details.  Most physicians don't understand reports like these completely.  The key is knowing what information is important.

1. You are able to exercise to 5.8 METS.  That gives us objective information as to how much exercise you can perform.  This info must be interpretted in context of your age.

2. There were non specific EKG changes -- nothing that looked bad, it just changed from basesline and definite conclusions can not be drawn from it.

3. You have normal left and right heart function that improves with exercise, as it should.  Your pulmonary artery pressure increase during exercise and are likely the cause of your symptoms.  This is measured indirectly by calculating pressure across the tricuspid valve (2.6 m/s to 3.7 m/s).

The left atrum index takes you left atrial area or volume (calculating on echo) and divides it by your body surface area.  It is better to a have lower result here than a higher result.

I hope this helps answer your questions.  There is a lot of information there but not all of it is relevant, so it is easy to get lost in detail.  Good luck and thanks for posting.