I am a 32 years old male (5-7, 140 lbs) with good health habits. For the last six years, I had a history of light-headedness and fatigue. Since last May, I have been experiencing chest pain, irregular heart beat, and reduced exercise capability. An Echo done in last June showed no abnormality in my heart, with a pulmonary artery pressure (PAP) of 32. A blood test showed high TSH level (6.02 MIU/L), but it came down to normal in two other tests months later. Since then,I have developed further symptoms such as short of breath, tight throat, back pain, blue/purple discoloration (after shower) and varicose veins in hands and feet. A stress Echo done in last Oct. showed a mildly dilated right heart ventricle, moderate TR and PI, and PAP of 46 at rest and 55 at peak exercise. A right heart Cath in last Nov. measured a normal mean PAP of 17 mmHg (25/12) at rest and 14 (22/7) after exercise. However, an abnormal increase in oxygen saturation (85.7%) was discovered in my IVC blood, compared to 70% in SVC. The cardiac output was 5.79 liters/min. So an arteriovenous shunt was suspected and MRI tests were done for the chest, abdomen, and pelvis regions with normal results.
My doctors seem to be out of ideas and my conditions keep getting worse. What is your take on this case?
(1). How accurate and reliable is Cath in terms of measuring the pulmonary pressure?
(2). How abnormal is O2 saturation 85.7% in IVC blood? Is it a definite indication of AVF?
(3). Without MRA, is MRI enough in detecting AVF?
Thank you very much for your time and any advice will be high appreciated.