I am a 37 year old female, normal weight, history of allergic asthma, and diagnosis of mixed connective disease. Recently I have experienced SOB and dyspnea while working out. I had started working with a new trainer and contributed it to that, but after about 6 weeks there was no improvement, and my trainer suggested I see my Pulmonologist . CPET was ordered. Results mildly low CO2 at peak, decreased O2pulse at peak, and low VE max. No EKG abnormalities. He ordered a new ECHO and referral to cardiologist. Last ECHO, a year ago, showed LAD of 4.2, mild diastolic dysfunction, RVSP of 33, and intra atrial septum aneurism. Pulmonologist told me I needed to push this, given new symptoms and MCTD. My mother really wants me to look hard for a cardiologist and inquire about a cardiac rehab program. I am not a person who questions doctors, and am worried about looking like a hypochondriac . Is this something I need to push? I don 't want to ignore something that may progress into a bigger issue. Should I be pushing for more aggressive treatment of MCTD or is that in no way related to this. I am not sure what issues are related. I am worried that no one is connecting the dots.
The relatively good news is that the data that you provided me is not suggestive of significant pulmonary hyertension or signficant cardiac disease for that matter (although some of the info you provided me from the CPET doesnt exactly make sense but dont worry about it--I was still able to interpret).
Having said that, I do suggest hat you be evaluated by a cardiologist so that you can hopefully put most of these concerns behind you. I think this is important. It is true that MCTD can sometimes be associated with cardiac disease. If after a through evaluation your cardiologist suggests invasive testing (a right heart catheterization), this will be the test that would definitively rule out pulmonary hypertension. In the meantime, he/she will also make sure there are no other cardiac abnormalities.
Regarding your MCTD, this is not my area of expertise but between your rheumatologist and pulmonologist, I trust you will be well cared for (if you dont feel you are receiving the attention you need, you can always seek a 2nd opinion).
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