Pulmonary Hypertension/RIght Heart Failure

[toby7]

Hi, I posted this on respiratory disorders, but it might better be suited here.  

I had a stress echo that showed a moderate pulmonary hypertension with a pressure of 42 mm/Hg, moderate tricuspid regurgitation, mild right ventricular dilation, and mild mitral insufficiency. I had an echo three years ago which showed none of this, also I've developed an ejection systolic murmur in the upper left sternal border where s1 is greater than s2 and s2 is split.

1. I know the next step is catherization to diagnose hypertension, but do you know of other problems this could be?

2. Is a stress echo usually accurate when it comes to reading pressures? I've heard that pressures are lower than catherization and I've also heard they're higher?

3. If the right ventricle is mildly dilated, how long will it take to have full heart failure? What do you think my life expectancy is? I'm only 32.

4. Why does pulmonary hypertension cause you to be so tired and breathless?

Also, I had a pulmonary function test that showed low diffusion capacity in the mild range.

Thanks for your help. I really do appreciate it! It's hard to find a good doctor these days, and you are doing a good service for people.

[Cleveland Clinic]

toby,

thanks for the post.

1. I know the next step is catherization to diagnose hypertension, but do you know of other problems this could be?

Toby, there are both cardiac and pulmonary causes of elevated pulmonary pressures. The list is actually quite long, but the work up is fairly straight forward and can generally be done by a cardiologist.  Your echo should give a hint whether the problems are dure to valvular dysfunction (from what you mention this does not appear to be the case).  A good cardiologist or pulmonary specialist should be able to perform the workup.

2. Is a stress echo usually accurate when it comes to reading pressures? I've heard that pressures are lower than catherization and I've also heard they're higher?

Pressures may be higher or lower. Unfortunatley, an echo doesn't directly measure pressures it measures flow using doppler ultrasound.  Using several assumptions, pressures are calculated form the velocities.  There are conditions that make these assumptions incorrect and can lead to falsely elevated or decreased readings.

3. If the right ventricle is mildly dilated, how long will it take to have full heart failure? What do you think my life expectancy is? I'm only 32.

Its impossible to answer any of these questions, without knowing the cause of the findings.

4. Why does pulmonary hypertension cause you to be so tired and breathless?

Elevation of pulmonary pressures can lead to chronic changes in the lungs that make oxygen uptake more difficult and in the heart that make the heart function suboptimally.  These factors combined lead to shortness of breath.


The heart findings you mention and the results of the pulmonary test are non specific and are consistant with your other findings.

good luck

[DottyCece]

There are good Pulmonary Hypertension websites where you can locate cardiologists that specialize in this disease.  I personally know of a Dr. Diane Zwicke in Milwaukee who has specialized in this disease for a long time.  You can find her on the pulmonary hypertension website.