PH and blood clot

[fp1370]

I had an CT with contrast recently looking for a pulmonary embolism (for an unexplained fainting incident). The CT PET showed no sign of a pulmonary embolism - past or present. It did show an enlarged right heart. That finding led to an echocardiogram. The echo reported pulmonary pressures of "at least 36" and also described an enlarged right heart and mild tricuspid regurgitation. My internist said this was "mild pulmonary hypertension" and pointed out that I had had an echo done three years previous that showed pulmonary pressure of 46. He decided that the fact that the pressure had gone down meant I did not have Primary PH, but rather secondary PH. He said that since it was going down, whatever the secondary cause was must be resolving itself, so I need not worry about it. He speculated that it had been caused by a Pulmonary Embolism I "probably had" when I was 17 - I am now 54. (When I was 17 I had a deep vein thrombosis from 3 days of birth control pills. I was hospitalized for two weeks and had 4 benign chest xrays and no chest pain.) My question is, could my PH really have been caused by an event (which we have NO objective data to prove even occurred) 37 years ago? If dropping from 46 to 36 in two years indicates its rate of decrease, then what was the pressure at the time of the speculated event and why wasn't I debilitated from PH symptoms throughout my life and two childbirths? Why do I only in the past three years have SOB, profound fatigue, Raynauds phenomenon, decreased exercise ability and chest pain - reasons I went to doctor in first place? Does this "blood clot 37 years ago" theory explain my PH? I wonder if I should have a RHC. Couldn't the difference in PH pressures also be due to the indefinite nature of echos and the particular technicians? I would appreciate your opinion very much.

[fp1370]

Thank you for your response. I should have added that I am slightly below normal weight, have been found negative through the usual tests for sleep apnea, asthma, and any connective tissue disease. I have never smoked and my pulmonary functions tests were all normal. Again, no evidence of chronic or acute Pulmonary Embolism exist. Given that the usual secondary causes of PH have been ruled out, this is why I am concerned about the possibility of Primary PH. As you appear to agree that my clear CT chest scan for PE rules out the theory of a 37 year old clot causing my pressures and enlarged right heart, would you think a Right Heart Catheterization would be a logical and prudent step?

[Darcy Green Conaway, MD]

I think your situation is much too complicated to discuss on an online forum, but I will try to help you as much as I can...
to answer your questions:could your PH really have been caused by a PE at 17?
  yes, that is possible-- some people have "chronic emboli" but if you had a CT chest and this was not found it is not likely the cause of the mildly elevated pressures

dropping from 46 to 36....well, echocardiograms sometimes underestimated the degree of pulmonary hypertension. so it either means the echo underestimated the PH or it has truly decreased. I would look into other etiologies...lots of things cause elevated pulmonary pressures-->obesity, obstructive sleep apnea, asthma, emphysema, smoking, etc.

why do you now have fatigue and Raynauds?
   there are connective tissue diseases that can affect the lungs and cause Raynauds. this should be a discussion with your primary physician--perhaps even consider a pulmonary consult or a rheumatology consultation.