Pulmonary hypertension

[rudy1996]

I had a pulmonary pressure of 30 last year and 44 this year.  I am scared and will be starting further tests.  I have a triscupid moderate to severe leak that has been going on.

Is an ecoho accurate???

[heartofwisdom]

After hernia surgery in Nov my heart was erratic so the surgeon ordered an echo. my echo showed a pressure of 45-50 resting. No one bothered to tell me me about it.

Now 6 months later a new cardiologist-- I went to see for fatigue and throwing PVCs, Sob, --finds this report in my files (see below).

Shouldn't 50 at rest been a red flag? Don't you think I should have received follow up? Or was this discounted because I was just out surgery and on morphine?

I'm having more test this week.I'm getting weaker by the day.

Report

Hernia, preop. The patient also, with ancillary diagnosis of mitral valve and tricuspid valve disorder.

1. This is a technically suboptimal study but fair.

2. The cardiac chambers appear normal in size with a left atrium of 39mm aortic root 36mm. The left ventricle is 49 mm. The septal and posterior wall thickness suggest some asymmetrical type of left ventricle hypertrophy. The left ventricle ejection fraction is vigorous at 70%. RV systolic function also normal.

3. There is some mitral thickening with mild mitral regurgitation.

4. The tricuspid valve demonstrates mild TR, TR jet velocities are consistent with pulmonary hypertension with RV systolic pressure suggesting pulmonary artery pressure in the 45 to 50 mmHg range.

5. There is no obvious valve vegetations, intracardiac masses or thrombi.

6. No pericardial effusion.

CONCLUSION:
1. Mild left ventricular hypertrophy. Normal ventricular systolic function. Mild thickening of the mitrail valve with some mild mitral regurgitation.
2. There is some mild tricuspid regurgitation. With indirect evidence of pulmonary hypertension. The pulmonary artery pressure is between 45 to 50.

Any comments welcome.

[National Jewish]

The degree of pulmonary hypertension depends on whether the pressures you cite are mean pressures or systolic pressures.  The mean pressure is when the heart contracts.  A systolic pressure of 30 is near normal, but 44 shows mild pulmonary hypertension.  The echo estimated pressures are usually reasonably accurate but need not correlate well with the amount of back-flow through the tricuspid valve.  The most common cause of tricuspid insufficiency is not abnormality of the valve itself, but dilatation or enlargement of the right ventricle, most commonly in response to pulmonary hypertension.  And, one of the most common causes of pulmonary hypertension, in a young adult is mitral valve narrowing, also called stenosis.  However any disease process that results in enlargement of the right ventricle can cause tricuspid insufficiency.  Tricuspid insufficiency can also be congenital.

The good news is that while your pulmonary pressure is elevated, it is not highly elevated, and with treatment of the cause, may be reversed to normal.  The other good thing is that the large majority of conditions associated with mild pulmonary hypertension and tricuspid insufficiency are treatable.  You should proceed with the additional testing.