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Have pulmonary hypertension. Echo showing mild tricuspid and mitral regurgitation. Shortness of breath and ankle swelling on exertion

My wife has had 2 echocardiograms in the past 9 months. The RVSP was 42 first then 37 nine months later with mild tricuspid and mild mitral regurgitation . The cardiologist said she had pulmonary hypertension based on her symptoms and the 2 echos. He then performed a right heart cath which gave a PAP of 25/10, PCWP of 12 with wave to 15 and cardiac output of 3.5 & 3.6 (by 2 different methods). She has some shortness of breath upon exertion (ex. swimming a lap in the pool), her ankles will swell if she stays up too long and she gets cold fingers, feet and nose often. Based on the heart cath her cardiologist then decided that she did not have pulmonary hypertension. However, the pulmonologist still seems to thinks it is pulmonary hypertension and has referred her to a PH specialist in St. Louis for more testing. We are really concerned and confused. Does this sound like it is or is not pulmonary hypertension?
Asked On : Tue, 10 Jul 2012
Answers:  1 Views:  107
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Cardiologist 's  Response
Dear patient,

The diagnosis of pulmonary hypertension is not easy; echocardiogram showed mildly elevated pulmonary pressures, but the right heart cath is not consistent with primary pulmonary hypertension; the right sided pressures are actually normal AT REST. I think it is very reasonable for her to be seen at a specialty center; it may be decided that a repeat RH Cath may be necessary, particularly with an exercise phase (we get patients to ride a recumbent bike in the lab) to see how her pressures react with exertion.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
Answered: Tue, 23 Jul 2013
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