What is pulmonary hypertension when it isn't pulmonary hypertension?

[Claudia1964]

I am a 43 year old woman.  I have had a some regurg in my Mitral valve  for many years.  Over the past three or four years I have notice/complained about various sytems: dizzy, near fainting, chest pain, SOB.  I was sent to a cardiologist 4 years ago.  Her tech did an EKG, the card read it and said it was because I was skinny and should eat more salt.  I CONNOT eat any more salt!

Last year I discovered I was pregnant. When asked by the clinic doctor about any cardiac issues I mentioned the mitral valve (my father had his replace).  She sent me for an echo.  It showed I has RVSP of 40.  I was told I had to terminate the pregnacy and should consider steralization.  I was then sent to the Pulmonary Hypertension Unit.  I had another echo and it showed my RVSP was 41 and that there was some "tyrace" regurg in my tricuspid.

The PHU doctor doesn't think I have PH.....so what do I have.  I am having a very difficult time getting a cardiology appoinment....would it not make sense to see and EP or some other thype of cardiologist?

And what about reproduction and birth control?  What do I use for an effective BC method?  Do I still need to worry about pregnancy from a PH perspective?

Claudia 1964

[National Jewish Health]

Normal pulmonary artery pressure is usually stated to be 25/10.  A right ventricular systolic pressure (RVSP) of 40 is thus minimally elevated.  Depending on the degree of mitral regurgitation, it could contribute to a rise in pulmonary artery pressure.

It is true that pulmonary hypertension (PH) poses a considerable risk to both mother and fetus.  You should request further information from the pulmonary hypertension unit (PHU) doctor on why he/she believes that you do not have PH.  If this consultant is correct, then one would not consider termination of pregnancy.  You should seriously consider requesting a second opinion from another PHU doctor or another cardiologist.  One way or another you should do whatever is necessary to resolve this issue, which may require cardiac catheterization.  The correct diagnosis carries important implications for pregnancy and the management of the mitral insufficiency.  In addition, there is the possibility that you do have PH that is either primary or caused by something else such as recurrent pulmonary emboli or an undiagnosed left to right shunt.

You are a young woman, and in the interest of your current and future health, this issue must be resolved now.

[maggiemag]

An echo cannot diagnose PH.  Only a right heart cath is accurate, as an echo is only an estimate.  Many times people have elevated pulmonary pressures secondary to a left heart problem, like mitral valve regurgitation.  Did your latest echo mention the severity of mitral problem?  It sounds to me like someone over-reacted, and I would believe the PH guy if he is truly a PH specialist.  An EP doctor is for the electrical problems of the heart, like arrhythmias, so you probably don't need to see one.  Ask the PH doctor about birth control, but if he said you don't have PH, then you don't need to worry about birth control from that angle anyway.  Then check with your gyne.