Pulmonary Hypertension

[coloradoman]

I have questions regarding Pulmonary Hypertension. I had some problems with o2 during a stress test which resulted in a catherization of the left and right heart. The most significant pressures were (superior vena cava)

SVC mean =9mmHg and

PA (pulm Atery)= 32/26 (mmHg) mean values systolic/diastolic
PA (peak values) sys/dia =37/27
average value =28 mmHg

PCW Mean=16  A-wave=18  V-wave=20 mmHg

From reading I find that these measurements are the gold standard for defining the condition "Pulmonary Hypertension" They seem to know that the lung is the problem which makes it "secondary" PH. I don't have a scale (normal,slight, moderate, or severe") Could you describe the SPH severity from these numbers ?

[National Jewish Health]

Severity of pulmonary hypertension is assessed on the basis of pressures along with functional impairment as noted below.

Functional Assessment of Pulmonary Hypertension

Class I
Patients with pulmonary hypertension but without resulting limitation of physical activity.   Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain, or near syncope.

Class II
Patients with pulmonary hypertension resulting in slight limitation of physical activity.  They are comfortable at rest.  Ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near syncope.

Class III
Patients with pulmonary hypertension resulting in marked limitation of physical activity.  They are comfortable at rest.  Less than ordinary activity causes undue dyspnea or fatigue, chest pain, or near syncope.

Class IV
Patients with pulmonary hypertension with inability to carry out any physical activity without symptoms.  These patients manifest signs of right heart failure.  Dyspnea or fatigue may be present even at rest.  Discomfort is increased by any physical activity.

As you note, pulmonary hypertension can be primary or secondary to lung disease, such as chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), sleep-disordered breathing, alveolar hypoventilation disorders, or chronic exposure to high altitude.

Pulmonary hypertension is defined by the National Institutes of Health (NIH) primary pulmonary hypertension registry as a mean pressure of greater than 25 mm Hg at rest (normal 14 mm Hg) or greater than 30 mm Hg during exercise.

Mean pressures are weighted, ratio of systolic time to diastolic time, average of systolic and diastolic pressures.  The values you provide 32/26 are absolute, not mean values and are mildly elevated.  I am not sure if the peak values are with exercise, but in any event are mildly elevated.  You should discuss this with the physician who performed the catheterization and ask why your pulmonary capillary wedge (PCW) is elevated.

[coloradoman]

I will look into the PVH. I was reading the "http://www.cvphysiology.com/Heart%20Failure/HF008.htm" link which mentions when PCWP is 20 mmHg or above that there is risk of Pulmonary Edema. Mine were PCW Mean=16  A-wave=18  V-wave=20 mmHg  which seemed modulated by breath (Cyclical) max to min every 2 seconds.  hence the mean of 16 is lower than A-Wave and V-wave parameters. Is this normal? I am trying to find examples of this PCW wave measurements on the web to compare. My doctor will not comment on these.

[maggiemag]

No I have not heard of that.  Usually they talk about pulmonary ARTERY hypertension vs. pulmonary VENOUS hypertension.  If your wedge is up, then it would be pulmonary VENOUS hypertension and an entirely different animal.  It is extremely common, and treated totally differently than the PAH type.  One would treat the left heart issues first and that usually relieves the PVH.  Sometimes that means aggressively treating high BP.  The drugs for left heart are ACE inhibitors, beta blockers, diuretics etc.  These can also be used for right heart problems as well but other drugs like Tracleer, Ventavis, CCB's are mainstays for PAH.

[coloradoman]

Thanks for your comment. I does clear things up a little it is good to know the 2/3 and 1/3 rule. You must be knowledgeable on these things. I am concerned regarding the PCW value also. I read a paper on "Diagnosis and evaluation of pulmonary" hypertension" This document uses the PCW and PA data to classify the PM to post-capillary pulmonary hypertension. I'm not sure about this and I will see another doctor about it.  Have you heard of this diagnosis PCPH ?

[maggiemag]

I think what they meant is that the MEAN pressure of the systolic 32 over the diastolic 26 is approx. 28.  The 28 would be the mean pressure, not the 32/26.  The formula for calculating the mean pressure is 2/3 the diastolic pressure plus 1/3 the systolic.  That pressure of 28 mean would be considered mild.  Your wedge pressure of  16  might indicate a left heart problem, which can translate into your slightly elevated mean pressures.  Maybe this helps?!

[coloradoman]

Thank you for that well researched and truly useful information. I mean that seriously. The values of 32/26 are mean values not absolute. I have the waveforms I can show you if you want. The peak values are 37/27. When you add up the systolic on the waveform and divide by the number samples you get 32. The same procedure for diastolic. I did this manually for the systolic values (33+29+33+36+34+28+33+36+37+33)/10 =33.2, close enough. Why did you question the numbers I gave you ? Do you want to see the report ?