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Pulmonary Insufficiency

  I was so happy to have discovered this web site.  I have tried to do some
  searching on my own regarding pulmonic insufficiency, but I haven't
  been able to find very much about it.  I have tried using all of the
  major search engines, but I have been unsuccessful.  I only find
  articles relating to infants.
  My daughter, who is an adult, has been suffering from a heart
  condition for 20 years.  She was diagnosed with mitral valve prolapse
  in 1978.  During the late 1980's her health really started to decline.
  She would have problems standing for a long period of time.  She had a
  tilt table test done in 1992 which confirmed that she has autonomic
  nervous dysfunction.
  She recently had an echocardiogram done and the mitral valve prolapse
  is still there, of course.  However, now the echocardiogram shows
  pulmonic insufficiency.
  I have noticed that her hands are really ice cold, and sometimes her
  hands look purple while her fingers look kind of white. Her nails have
  a bluish color.
  She has a positive ANA, takes Lopressor (for beta blocking reasons -
  not for high blood pressure) and Rythmol.
  Can pulmonic insufficiency cause a person to feel really cold?  Please explain what pulmonary insufficiency is.  Any input would be
  *very* helpful.  :-)
  Thank you.
Dear Frances:
Pulmonic insufficiency means that the pulmonic valve is leaking.  There are numerous causes of this.  You do not indicate how severe the leaking is; also, you did not indicate if the mitral valve prolapse is associated with significant leaking of the mitral valve.  If there is significant leakage of the mitral valve,  that can secondarily cause the pulmonic valve to leak, through a backup of pressure in the blood vessels that deliver blood to the lungs (the fancy name for this is pulmonary hypertension).  Any of the many diseases that cause pulmonary hypertension can cause secondary pulmonic insufficiency; some of these diseases are associated with processes that cause positive ANAs or cold and discolored hands.  Connective tissue disorders and certain infections are among the possible culprits.
The most important question though is how leaky are the valves.  Another question is whether there is pulmonary hypertension.  A good echocardiogram can answer these questions.
In addition to seeing a cardiologist, your daughter should see a rheumatologist to investigate the cold and discolored hands further.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.

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