When to get a second opinion?

[Chele68]

I was recently sent by my rhumetologist to have an echocardiogram. She heard a heart murmur and wanted that checked. I was diagnosed with rhumatoid arthritis 12 yrs ago, and have been taking methotrexate (1 cc per wk) for 10 yrs with no problems. My echo showed mild tricuspid regurgitation and mild HP (it said the pressure was 35-40 mmHg). My primary physician isn't concerned by the results since I don't show many symptoms, no tighness in chest, shortness of breath only on heavey exercise. She wants me to have another echo in a year. Is this prudent or should I insist on seeing PH specialist and/or confirming the results with a heart catheter?

[CCF-M.D.-RCJ]

chele68,

Thanks for the post.

Q:"Is this prudent or should I insist on seeing PH specialist and/or confirming the results with a heart catheter?"

I don't routinely send someone with the numbers you listed to a PH specialist, nor do I routinely confirm the numbers with a right heart cath.  But remember, I have never seen you specifically, so I can't comment on the "prudence" of this decision in your particular case.

Talk to your rheumatologist, he/she may have specific opinions of what to do or not to do with the methotrexate therapy.

Hope that helps.

[Dr. Erik]

Only you can decide what is prudent or not. It is reasonable to follow your doctor's advice as well as it would be reasonable to seek a second opinion. Whatever will give you peace of mind is the prudent thing to do. Good luck.