hypertrophic cardiomyopathy and pulmonary hypertension

[sugarcane]

I have a few questions about hypertrophic cardiomyopathy, having been diagnosed about 5 years ago at the age of 45. For the first time on a recent echo, I read in the report moderate pulmonary hypertension with a systolic right ventricular pressure of 48. Never any mention of PH before. Is this a natural progression of my HCM?
Could pacing have caused this? ( I have had a pacer for the last 4 years which did cause my gradient to fall from 60 at rest to 15 but has not improved my symptoms of chest pain and SOB.)
Is the PH diagnosis reliable just by echo?
Is this an indicator of a poorer prognosis?
Should my treatment change if I do have PH? I am currently on a beta blocker, calcium channel blocker, and Norpace plus the pacer which was inserted for bradycardia from all the meds and also in an effort to reduce the obstruction, if I understand correctly.
My provocable gradient with Dobutrex is 160, with exercise is only in the 40's although when I have a stress echo, I am always fasting which I do not believe is a true indicator of how I feel every day when I have eaten. (Symptoms are so much worse after eating even a small meal, that I feel my gradient has to be higher when not fasting.) Why are stress echoes done while fasting and do you think that is an accurate way of measuring gradient (obstuction)in an HCM [patient?
Thank you for your insight.

[gtojohnny]

See what I mean? silence!!

[gtojohnny]

I too have HCM and I too experience discomfort after eating. The Doctor's don't know what causes this and don't know what to tell you about it. In fact, they are strangely silent after you mention it as if they don't believe you. I have noticed that foods that are processed or high in sodium, fat, and sugar are the worst. If I eat wholesome food like fresh prepared lean meats or vegetables, I am fine. I also am on a Beta Blocker and Norpase. The Norpase has worked wonders for my gradient. The key to feeling well for me is to eat well.

[CCF-M.D.-MJM]

HI sugarcane,

Sorry to hear about your symptoms.

Is this a natural progression of my HCM?

It can be.  The systolic anterior motion (SAM) of the mitral valve can lead to mitral regurgitation.  PH has MANY causes, but one of them is MR.  This can happen if you have significant MR from the HCM.  Decreased diastolic filling can also cause PH.

Could pacing have caused this?

Probably not, unless the pacer wires are affecting the tricuspid valve.  If the pacing hasn't improved your symptoms and your symptoms are significant.  There are both percutaneous (alcohol injection into a heart artery during cath) and surgical (myectomy) solutions to improve symptoms.

Is the PH diagnosis reliable just by echo?

Echo is very reliable. It is more likely to underestimate than over estimate.

Is this an indicator of a poorer prognosis?

It can be, but it completely depends on the clinic circumstances.

Should my treatment change if I do have PH?

That is questions only an office visit will answer.  Like I mentioned above there are mechanical treatments that are helpful.  When my grandmother was diagnosed with a symptomatic form of HOCM, I referred her to Harry Lever here at the Cleveland Clinic.  I TRUST Dr. Lever and he is always good to either provide a single consult or to follow your care as your primary cardiologist.  His practice is almost entirely HCM.

Why are stress echoes done while fasting and do you think that is an accurate way of measuring gradient (obstruction) in an HCM [patient?

Any study with potential complications is done fasting because if there is an emergency, we need to be able to safely secure an airway (intubation).  Recent meals increase the risk of aspiration pneumonia.

I have heard other HCM patients mention their symptoms worsen after meals but I do not know why this is the case.

I hope this helps, good luck, and thanks for posting.