Mild tricuspid regurgitation and pulmonary hypertension? I am SCAREDDDDD

[silviaordonez]

Good afternoon. I am a 31 year old female with a healthy life style. No illnesses or family history of heart disease or HP, but Thyroid problems. I am an anxious person and really nervous. I was sent to the cardiologist for a little chest pain after running more than 5 minutes so they sent me to see the cardiologist just to make sure (the pain was not like an angina it was just a little pain in the chest). I had several EKGs and they were normal, I also had a stress test and it was normal. And then, the problem came. I was ordered an Echo cardiogram just to make sure everything was perfect. The doctor told me that in the cardiovascular examination everything was normal, no murmur, leaks or clicks. In the echo it says that everything was normal but a mild tricuspid regurgitation with mild pulmonary Hipertension 35-40 mmHg (38 to me exact). However, my left ventricule and right ventricule are ok acording to the test. No dilatations or anything like that. The RAP is 10.0 mmHg wgich I read to be normal and the Pulmonic artery is normal with a peak velocity of 1.0 m/sec. The TR peak velocity is 2.6 m/sec and the TR peak grad is 28.1 mmHg. I was doing research for 1 month but everything I read makes me scared and I got a panick attac, anxiety and depression because of that. I am now on meds for these episodes. The cardiologist did not give me any treatment but he said I had pulmonary Hypertension and thta I needed to have an eco each 6 months from now on. However, I read that an echo does not diagnose this catastrophic disease? as a matter of fact my TR velocity is less than 2.8 which I read is maybe not a HP. I had labs, ekgs Xhest X rays and an angiogram and all my pulmonary trees brances and everything are normal. Another doctor told me that is not HP and that my regurgitation was functional that is why it was not PH that maybe it was due to the severe anxiety I have been having before the test and after the test. It is also winter here and I have had a little sinus and allergy thingy going on. I had never had this things before and I almost never get a bad cold or something like that. I AM SCARED to death begging God everything is normal and that maybe the Echo was overestimated because the day of the test I was sweating and dropping and shaking of fear.

I appreciate your help and any comment on this.

Silvia

[silviaordonez]

So it is not related to shortness of breath or something like that? I mean is something the normal body does?

[markmsn10]

Sigh or yawning is typically a stress response or anxiety.   no need to worry.

[silviaordonez]

Hi Mark thank you very much for your response you have been much of a help in my condition. I have another question for you. Like 3 weeks ago, I have felt that I have to sigh all the time. It is like my lungs need air. However, if my body does not do it voluntarily, I look for the sigh. I do not feel shortness of breath when I walk or go up stairs. I live on the third floor and go up 40 stairs of course you feel a little tired but no that lack of air as it is described in the definition of shortness of breath. I went hiking last week to the mountains and I felt fine. No dizziness or chest pain when walking and going 6,000 feet to the mountain (I did not walk that much though I just went for the trail for 40 minutes in an inclined trail). My question is, sigh is a symptom or a synonym of shortness of breath? I am an anxious and depressive person and I am taking medicine for that now.
Thank you very much for your help Mark.

Have a blessed night
Silvia

[silviaordonez]

Hi Ger,

Thank you very much for your response. I apologize if I bother you a lot but as I said I am an anxious person and everything worries me :-(. I am under psychiatric treatment and therapeutic guidance for this and they say that I may have this echocardiogram readings due to my depression and anxiety since that day I was really anxious(the day of the echo). Also, my normal heart rate at rest is 65 and the day of the test was 87. My blood pressure is normally 107/56 and that day was 120/70. When I get nervous or scared that usually happens to me but after a minute or two all comes to normal. Could that have been the situation with my abnormal readings?

Finally, when I did research about the tricuspid regurgitation it talked about some symptoms I do not have, however that active pulsations or beating in the neck veins what does it mean when I touch them? when I touch my pulse in my neck. I moved my neck to one side and I could see my beating in my neck is that normal due to the position in which I had my head?

Thank you very much Ger one more time

Silvia

[silviaordonez]

Hi Mark,

Thank you very much for your response. I apologize if I bother you a lot but as I said I am an anxious person and everything worries me :-(. I am under psychiatric treatment and therapeutic guidance for this and they say that I may have this echocardiogram readings due to my depression and anxiety since that day I was really anxious(the day of the echo). Also, my normal heart rate at rest is 65 and the day of the test was 87. My blood pressure is normally 107/56 and that day was 120/70. When I get nervous or scared that usually happens to me but after a minute or two all comes to normal. Could that have been the situation with my abnormal readings?

Finally, when I did research about the tricuspid regurgitation it talked about some symptoms I do not have, however that active pulsations or beating in the neck veins what does it mean when I touch them? when I touch my pulse in my neck. I moved my neck to one side and I could see my beating in my neck is that normal due to the position in which I had my head?

Thank you very much Mark one more time

Silvia

[Ger57]

I too have mild tricuspid regurgitation. Don't worry, Silvia. You are just fine!

[markmsn10]

Yep-- I have the same mild tricuspid as you.   No need to worry!   You'll find hundreds of others with similar questions and are all normal as well!

[silviaordonez]

Last question Mark, did you also have mild tricuspid regurgitation in your readings?

[silviaordonez]

Hello Mark one more time

I am sorry to keep bothering you with the same topci but right now I am really anxious and depressed because of this findings. I do not know if I mentioned to you that I have lost 10 punds in the last month due to depression and anxiety for this situation. Before the echo was done I was under medication for mild anxiety too but they day of my stress test and the echo I was full of anxiety and nervous. Do you think that could have messed up the readings? or maybe the allergy I had due to the cold winter? or the little sinus infection I had for 2 months? Let me tell you what is what my mind thinks. That it is the beginning of a PH and it will progress and I will die in a few years or that my life will be impaired due to this devastating disease, that my heart will eventually enlarged and I will start having all the symptoms. I look at my feet everyday for an edema and I check my pulsations everyday, if I feel a little pulsation in my neck I get worried, all my muscles are stiff, I have lots of tension and I feel a little pain on my chest near the arm pet. I tend to externalize everything and my body does it too. I am really scared. However, I have another question. I read that it is unlikely to have PH if your tricuspid regurgitation velocity peak is less than 2.8 and mine is 2.6 which a gradient of 2.8 but it did not say anything about the gradient in the research I found. To be honest my symptoms are fatigue (but not extreme) and I know the antidepressants and anxiety medicine cause those effects. I did not feel like this before the findings. Also, they did the echo because I felt a little pressure in the middle of my chest when running more than 5 minutes but I have been 8 years without exercising. I bet all people feel the same. As far as stairs, I live on the third floor and what I feel is the normal feeling when you climb stairs.

I really appreciate the time and patient you are having with this anxious person who is begging God to be healthy again.

God bless you

Silvia

[markmsn10]

Yes-- the echo was really enough.   You MUST have more evidence than just that pulmonary pressure reading-- if you do a search in this forum you'll find dozens and dozens of others with the same question.   No you do not have PH.   Relax and enjoy life!!

[silviaordonez]

Hi Mark thank you for your response,

I have been worried because I read that one of the causes of TR is the PH :-(. But now that you mentioned it. Th rest of my echo and especially my right ventricle and its function it says normal. and My EF is 68. I do not know if I mentioned that my pulmonary angiogram was normal and my labs and C X rays normal as well. Will it be enough to say that I do not have PH?

[Ger57]

Hi Silvia,
As I already said and markmsn10 too, a single echo does not give reliable results.
If there is an indication for PH, blood tests, chest X-ray and echo are done.
That is what you had.
After all results are reviewed and serious doubt remains, a right heart catheterisation will be done to measure pressures in right ventricle and pulmonary arteries. That will give most reliable answers.

If your cardiologist has not ordered that, he must have concluded from ALL the previous tests you are not having PH.

[markmsn10]

You are correct-- that is a completely normal reading.    For your earlier response:   The cardiologist should never have diagnosed PH-- it is impossible to say for certain with a single echo.   The wording should have been used as "Evidence of possible PH" but your echo was normal.   Also-- echo has shown to be off as much as 10mmHg in the estimation of pulmonary pressure.   Simple things can throw this number higher like a smaller pulmonary valve or smaller pulmonary artery (Would have been seen on echo)   Right heart cath is the only true way to diagnose.

Been through stuff like this-- seriously you can get one completely different interpretation from one doctor-- then swing the opposite way on another one.    Echo normal-- you are normal.   Single reading of a higher pulmonary pressure is not accurate.

[silviaordonez]

Hi Mark thank you one more time

My echo says that the right ventricle is normal is size and function and that my atrial pressure is 10mmgHm which I think is normal. The cardiologist did not say anything about that atrial pressure and I found in one site that 10 mmGhm is normal am I right?

[silviaordonez]

Hi Ger

Thank you for your response!

I understand what you are saying, but then why the doctor made me have x rays, chest angiogram all kinds of lab tests and it showed normal function of my pulmonary arteries, heart, aorta and veins. Why did the cardiologist say that I had pulmonary hypertension and wanted me to take medicine (amlmodipine) if the only finding was the high pressure 35-40 mmgHg 38.1 to be exact and the regurgitation 2.6 m/s which I read is very unlikely with the velocity that I can have HP. The rest of the exams were perfect with no evidence of lesion or abnormal fillings in the pulmonary arteries. I have had allergies and a mild sinus infection due to the winter. If I had HP wouldn't I have dilatation of the right ventricule and many other things that I wrote in my first comment? additionally, should not I have evidence of pulmonary lesions?

Thank you

Silvia Ordonez

[markmsn10]

No--  almost everyone has tricuspid insufficiency and is found in 80%+ of normal people.   There is nothing wrong with your heart and this is a normal finding.   For Pulmonary Hypertension - The general idea was that pulmonary vascular restriction causes increased pressure in the lungs which uses the tricuspid valve as a blow-off (insufficiency).   This isn't always the case and with normal population studies-- almost all of those 80% do NOT have PH at all.    This is just something a normal heart does (Even mild mitral, pulmonary and trivial Aortic are common)

So let me repeat (Echocardiogram is NOT a valid diagnosis machine for Pulmonary Hypertension)  It is not accurate unless other evidence is found (heart size/function and especially the right ventricle/atria)   If evidence supported it they would order a right heart cath (which even so-- many times is normal)

[silviaordonez]

Hi Mark,

I read the report you sent me thank you very much for sharing! However, I have some questions what does the tricuspid regurgitation has to do with it? is it because of the PH or it is just something normal that can happen? I am scared about having another echo and find out that the problem has worsen. I do not know what to do. This situation almost made me crazy and I am now on therapy and psychiatric taking meds. There is not enough documentation about mild pulmonary hypertension and my question is if my heart is ok why the HP?

[silviaordonez]

Hi ed34

Thank you for your response! Do you think anxiety could have made my pressure to go up the day of the test? Well, the rest of the exams are perfect and there is not an underlined heart or lung condition behind this. This situation made my mind unstable and now I am with therapist and psychiatric to treat my anxiety and depression that this exam caused me :-( I beg God everything comes back to normal.

[Ger57]

Echo Doppler values need to be taken with a grain of salt especially when you are looking at isolated values. This counts for measured pressures, speeds and dimensions. Believe me, I experienced this a few times already.
Only if you look at the whole picture, so all values and preferably over a longer time (results of >1 dopplers) you get a good and reliable impression of the heart's condition.

So, having a doppler in 6 months (and perhaps one at 1 year from now) would be a good idea. Then they can compare results, see if there is a trend.
I think you are alright though. "Mild" is not something that you should worry about too much.

[markmsn10]

Another snipit:

Diagnosis
jxk335: Is a diagnosis made by an echocardiogram accurate?

Dr__Omar_Minai: No it is not. Echocardiography (echo) is the best non-invasive screening test we have; however, it is not a good diagnostic test. Over the years I have seen many patients for whom the echo was incorrect either in making the diagnosis of PH or in determining its causative factors. Current PH guidelines recommend that all patients being considered for treatment for pulmonary hypertension absolutely have to have a right heart catheterization for accurate measurement of their pressures. Right heart catheterization also helps us make diagnoses that echocardiography can miss, and helps the physicians determine long-term prognosis, as well as to select appropriate treatment.

[markmsn10]

Deep breathe through nose-- exhale through mouth.   You are just fine!    The overestimation of PAP through echocardiogram is VERY well documented.   It should never be used to diagnose Pulmonary Hypertension especially without underlying evidence (hypertrophied LV and LA)   There have been people getting numbers as high as 50 mmHg and so worried they wanted a right- heart cath.   They then found out their mean was less than 22 mmHg.   I found out I had 35 mmHg in an echo 13 years ago (no I haven't been back to have another one)  but that number was number was never mentioned to me.   You will find many others worried about these numbers when they just mean nothing at all.    

Please read this article from a great source about the inaccuracy of pulmonary pressure study by echo.

http://www.erj.ersjournals.com/cgi/reprint/12/6/1476.pdf

[ed34]

Sounds as though you are in the clear and it was an anomaly which threw them. I personally think it's all down to tension (anxiety) which can throw readings all over the place. If I was you, I would take a deep breath, relax and admit your heart and pulmonary system are just fine.