Enlarged right heart.

[blizzard2014]

What can cause a moderately enlarged heart, but normal ejection fraction. I also have almost normal Pulmonary Artery Pressure at 20.48. I did have large PE's six years ago, but they have since cleared out. I have high blood pressure spells when standing, normal BP when sitting. I get fast heartbeat sometimes also. I can get a heart rate of 130 BPM just from grating cheese. I am on BP meds to control the high BP when standing. Without meds, my BP can go from 116/78 when sitting to 170/120 just from standing up and walking around. The ER doc said it could be a heart issue causing this and send me for the Echo. The Cardiologist will not even take into consideration my high BP when standing as he says you can only get low blood pressure from standing, not high. My PCP is also stumped and called it liable hypertension. Even with 20-50 mgs of Lisinopril and .2 mgs of Clonidine, my BP will still jump to 130/95 when standing. I have caught my heart rate dropping to the 40's before and also sometimes my oxygen levels drop when walking or doing work. They quickly bounce back up again though. I failed a lung function test two years ago. I had low FEV1/FVC and low DLCO gas exchange. It showed both a restrictive and obstructive pattern, but my HRCT scan of lungs showed normal looking lungs. I also had my oxygen drip to 91 during a 6MWT on the pulmonary doc's 02 meter. So, I know it's not just a fluke with my meter. What do you think this can be from? Also, can taking Lisinopril and Clonidine cause my Pulmonary Artery Pressures to be lower? I have never felt the same since large PE's. I had a VQ scan to rule out chronic clots in the lungs and it came back normal. Can there be gas exchange problems in the lungs that do not show up as ventilation and profusion defects on a VQ scan? I feel tired all of the time. More tired than these issues should make me feel. Sometimes I wonder if I'm a hypochondriac and should just ignore all of this stuff.

[blizzard2014]

I also wanted to note that I have diabetes, sleep apnea, several blood clotting disorders. I used to have swollen ankles before starting blood thinners. My DLCO was 46. I don't know if you can fudge a DLCO test. I also get wild FEV1 readings from 70 down to 40, all within the same day. I never blow an FEV1 over 70 though. I bought a spirometer and did the tests over and over again just to see if maybe I didn't try hard enough during the lung function tests. I had a Normal chest X-Ray 1 year ago that did not spot the right heart enlargement. So, either they did not see it, or it is something that has only revealed itself in recent months. I have failed three ECG's in the past three years. Two of them were borderline diagnostic for Left Ventricular Hypertrophy. The last one that I had when I went to the ER with the wild BP swings said that I meet multiple criteria for Left Ventricular Hypertrophy, but the echo showed normal LV.  I decided to cut ties with the heart doc because he rushes me and does not explain things. He barged into the room and said not to worry about the enlarged heard because my ejection fraction was normal. I had to request copies of my echo scan just to see what was going on. I do know that blood clots in lungs can cause an enlarged heart, but all of the people I know who have had a enlarged heart from blood clots in the lungs have had their hearts return to normal size after 6 months to a year. For me, it's been six and a half years.