Concerned over Severe TR

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Hi, i am 28 Yr old Male and have had Isolated Severe TR for like 3 years now and i had mild dilation of my RV when it was diagnosed. Now i had Echo 8 months ago that shows it now being 'Moderate' with my Pulmonary pressure estimated at 37 !! I find this quite alarming and I am showing some symptoms like pulsing veins, tiredness and chest pain (dull aches). I stressed this with my cardiologist and he casually said the pains not related to my heart and that i can carry on doing exercise as normal. I find this hard to believe and he didn't even show any concern on getting another echo ? Is there any reason for me to show concern ? What could be possibly causing these daily episodes of dull chest pain (last hours) ? Any help would be appreciated !

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Yeah, my cardiologist has just said he will do another checkup in 6 months without any form of Echo !! I have moved to a new hospital. I think i need a second opinion he also said that my pains and symptoms where nothing to do with my heart condition even though the pains have started ever since I have had Severe TR !! As for my veins pulsating i get it mainly in my legs and occasionaly in my arms also but has only happened in the last 2 years along with my chest pains. Ive never had a TEE but it sounds a good idea but i know  
how bad doctors are around here are !

[ed34]

I think the pressure stated in your report is probably systolic, the pressure you indicate is more like diastolic. Anything up to 30 is ok, this is when the heart is squeezing blood out, so the pressure will be higher. Diastolic is when the heart is relaxed, filling.
If your right atrium is increasing in size, then there are two possibilities. You have pulmonary hypertension where there is a problem in the pulmonary system and a pulmonary specialist should be sought. It could even be a lung problem. The second possibility is the regurgitation from your tricuspid is allowing too much blood to backup into the right atrium.
As stated above, an echo is not accurate for many things, it does give clues though about what should be looked into next. I think your cardiologist should order a TEE scan for your valves. This is a Transesophageal Echocardiogram which is far more accurate for measuring regurgitation. If your right atrium has gone from mild to moderate dilation, then there is OBVIOUSLY a problem. If the size increases too much, there is a risk of the tricuspid valve being forced out of shape, really making matters much worse. I would get tough with your cardiologist, ask why the RA has increased in size. Ask what he intends to do to stop it getting larger, ask what will happen to your TR if is grows much larger. I wouldn't waste time with another standard echo, but a TEE instead.

[t10179uhn]

Please don't panic.  Echo's are NOT the gold standard for diagnosing pulmonary hypertension.  When you say your veins are pulsing, where exactly?  The veins that would be engorged and very visible with PH will be your right neck veins.  

Echo's are often wrong and often over-estimate pressures.  Normal values are generally <37, depending on what lab/institution is reviewing your echo.

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No the RV has increased to 'moderate' and valve is still severely Regurgitant, i had endocarditus at 21 which caused a moderate TR but has been Severe since when i was about 25 years old. I just think my onset of symptoms (specially the chest pain) is worrying me. And i believe 10-15 pressure is normal certainly not 30 !!

[ed34]

So, when you was 25, you had severe tricuspid regurgitation? and your right ventricle was mildly dilated?  Now at the age of 28, you had a new echo 8 months ago which showed improvement? the tricuspid regurgitation is now moderate? Your pulmonary pressure should be around 15-30 but is 37, a tad over the norm. When the last echo was done, was the right ventricle back to normal size? hence the TR improving?