Changes in ECHO after 6 mos

[edprof]

59 M, treated for mild Aortic Aneurysm, with normal limits on previous studies except fo AAA, had follow up ECHO 3 days ago.  Results are dramtically different:
---AAA same
---Normal LV Systolic function + Mild concentric LV Hypertrophy
---LA mildly Dilated
---RA moderately Dilated, RA pressure 15
---RV moderately dilated, RVSP at 30-35, IVC is plethoric and does not collapse w/ respiration
---possible PFO/ASD
---mild mitral reg
---all valves, normal, no pericardial effusion
---BP is 105/65, cholesterol is 121, meds--atenolol, Atacand, vytrion
---no symptoms--feel good---jog walk up and down hills 3-4 miles a day
questions
1.  What causes an increase in RA and RV in a short amount of time?
2,  RSVP @ 30 and RA @15, is indicative of mild pulmonary hypertension---what could cause that?
3.  what is the significance of IVC not collapseing with respiration? How is that treated?
3.1. Could the cause be a Pulmonary emboli?  
3.2  Are their conditins whcih can reverse the enlargements and get things more back to normal?
4.  Can i still jog?  Should i retire? Longevity?
5.  I feel i should be in a hosptial to figure our what is going on---need additional information because my searches are coming up with nothing good about pulmonary Hpertension

thank you

[Cleveland Clinic]

It is most likely that the PFO/ASD is causing the right sided enlargement and subsequent right heart failure. The pulmonary pressures are elevated into the moderate range because you have to add the RA pressure to the RVSP= 45 mm Hg. Chronic or acute PEs could have caused this change, as could an ASD. You should have a TEE to document flow across the inter atrial septum, as well as a right heart cath to really document these pressures. It your pulmonary pressures are elevated then a trial with nitric oxide to see if its reversible may help as well.
In the end, I think that if you have any symptoms or signs of right hear dysfunction on exam then you should have this PFO/ASD closed, percutaneously if possible. There is a very experienced physician at our institution which specializes in treating these disorders, and I can give you his contact information if you want it.

[mark29357]

A related discussion, cleveland clinic was started.

[edprof]

Thank you for getting back to me.  I am very anxious about my health. I have been to the CC for my AAA so i am familair wit your wonderful institution.  Yes, I would. like to know the name of the physician.  Is it possible to have these exams done at CC and based on findings, treatment while one is there?  Also, since these changes all occured within 6mos, is this something that requires urgent treatment on my part---i ask becasue of work commitments i have in the next 3 weeks and a vacation at the end of the month.