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Is PA Pressure Value Of 58 A Cause For Concern?
Question: I am TERRIFIED. I had an echo last year, an EKG, chest x-ray and exercise stress test. Everything was p normal except my PAP was 58 and he said minor leaking valves. I was to go back in a year. I did understand what PAP was then so when I saw cardiologist last week, I had done research. He said 58 was nothing to worry about and he would repeat the echo in 2 months. I have attached all my records including my 2002 echo I had because I took Redux for app 3 months back in 1996. I have read til my eyes are blurred, I cannot eat, sleep or function. This is a fatal disease and I am scared. I sent my 2 echos to another online Dr and he too said not to worry. BUT I AM Worried.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello!
Thank you for your question on HCM!
I understand your concern and would like to explain that after reviewing all your medical reports, I would give my opinion as follows:
Your overall cardiac evaluation (symptomatology and performed cardiac tests) reveals no actual evidence for any acute cardiac disorders or any increased risks for near future cardiac ischemic events.
But, as you have a history of hypertension, dyslipidemia, family history of CAD and for the more, not a zero Calcium score (though only mildly positive), it is more rational to continue treating all possible coronary risk factors, thus preventing coronary risk even more.
So antilipemiant therapy and a healthy life style are highly encouraged.
Meanwhile, I think that the most important issues to carefully consider are your atypical chest pain and increased pulmonary artery pressure.
As the pulmonary hypertension was not present in your first Echo report (2002) and it actually is around 60 mmHg (58), there is need for further investigations:
-First of all a Phen-Fen therapy implication on such Echo findings should be ruled in/out (as anorectics are well known for their adverse effects of inducing valvular dysfunctions and pulmonary hypertension). This may be achieved by excluding other possible causes of pulmonary hypertension (such as pulmonary embolism, chronic obstructive pulmonary disease, etc.).
-As your left ventricle function (systolic and diastolic) are perfectly normal (as concluded by your last Echo), the possibility of LV dysfunction on your pulmonary hypertension, is completely excluded.
- A chronic obstructive pulmonary disease is also excluded by your medical history, physical examination, chest x ray.. Nevertheless I would recommend a pulmonary function test.
- To exclude/confirm implications of a possible pulmonary embolism disorder, I would recommend performing some tests like: an arterial blood gas analysis, ventilation-perfusion pulmonary scintigraphy, pulmonary angio-CT, etc.
If all the above investigations result normal, then an adverse effect of your previously used Phen-Fen therapy may be highly possible.
Probably even your atypical chest pain may be issue related (related to pulmonary hypertension).
The best strategy to be followed in such case would be periodically scheduled follow up by cardiac ultrasound, to control pulmonary artery pressure evolution.
If persistent or increased PAP values are seen, then a possible specific therapy for pulmonary hypertension would be necessary to be started.
You have to discuss with your attending physician on the above mentioned issues.
Hope to have been of help!
Feel free to ask any other questions whenever you need!
Best wishes,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello!
Thank you for your question on HCM!
I understand your concern and would like to explain that after reviewing all your medical reports, I would give my opinion as follows:
Your overall cardiac evaluation (symptomatology and performed cardiac tests) reveals no actual evidence for any acute cardiac disorders or any increased risks for near future cardiac ischemic events.
But, as you have a history of hypertension, dyslipidemia, family history of CAD and for the more, not a zero Calcium score (though only mildly positive), it is more rational to continue treating all possible coronary risk factors, thus preventing coronary risk even more.
So antilipemiant therapy and a healthy life style are highly encouraged.
Meanwhile, I think that the most important issues to carefully consider are your atypical chest pain and increased pulmonary artery pressure.
As the pulmonary hypertension was not present in your first Echo report (2002) and it actually is around 60 mmHg (58), there is need for further investigations:
-First of all a Phen-Fen therapy implication on such Echo findings should be ruled in/out (as anorectics are well known for their adverse effects of inducing valvular dysfunctions and pulmonary hypertension). This may be achieved by excluding other possible causes of pulmonary hypertension (such as pulmonary embolism, chronic obstructive pulmonary disease, etc.).
-As your left ventricle function (systolic and diastolic) are perfectly normal (as concluded by your last Echo), the possibility of LV dysfunction on your pulmonary hypertension, is completely excluded.
- A chronic obstructive pulmonary disease is also excluded by your medical history, physical examination, chest x ray.. Nevertheless I would recommend a pulmonary function test.
- To exclude/confirm implications of a possible pulmonary embolism disorder, I would recommend performing some tests like: an arterial blood gas analysis, ventilation-perfusion pulmonary scintigraphy, pulmonary angio-CT, etc.
If all the above investigations result normal, then an adverse effect of your previously used Phen-Fen therapy may be highly possible.
Probably even your atypical chest pain may be issue related (related to pulmonary hypertension).
The best strategy to be followed in such case would be periodically scheduled follow up by cardiac ultrasound, to control pulmonary artery pressure evolution.
If persistent or increased PAP values are seen, then a possible specific therapy for pulmonary hypertension would be necessary to be started.
You have to discuss with your attending physician on the above mentioned issues.
Hope to have been of help!
Feel free to ask any other questions whenever you need!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry, but I am totally confused. First I no longer have chest pain. He thinks it was muscular. It went away after I had physical therapy and take breaks from my computer.
I took REDUX 19 yrs ago,and only for about 3 months. That is why I had the echo in 2002. That was 5 yrs after and it was all normal.
Are you saying I do have pulmonary hypertension?????? I PRAY NOT!
Is there a difference between pulmonary hypertension and Pulmonary arterial hypertension? I read there is???
Thank you.
I took REDUX 19 yrs ago,and only for about 3 months. That is why I had the echo in 2002. That was 5 yrs after and it was all normal.
Are you saying I do have pulmonary hypertension?????? I PRAY NOT!
Is there a difference between pulmonary hypertension and Pulmonary arterial hypertension? I read there is???
Thank you.
Brief Answer:
Just relax and follow medical instructions!
Detailed Answer:
Hi again dear XXXX!
First, I would like to explain that pulmonary hypertension and pulmonary arterial hypertension in daily clinical practice means the same thing (there exists also venous pulmonary hypertension especially in left heart dysfunctions, but as this consequently leads to arterial pulmonary hypertension it has the same meaning, just different etiologies).
I am exactly saying that based on your last ECHO report, you result with an increased arterial pulmonary pressure (normal PAP is 15 - 30 mmHg, instead of your 58 mmHg) ; that is, you have pulmonary artery hypertension. Don't panic!
As, I explained you above, it is necessary to perform a differential diagnosis, to exclude possible causes (anorectics therapy among them).
I hope that when you will perform the next cardiac ultrasound, that increased pulmonary arterial hypertension will be decreased (???!!), but I am afraid it is going to persist.
So, if pulmonary hypertension is confirmed by repeated ECHO, then the above mentioned advices are necessary to be followed.
Anorectics adverse side effects in regards of your cardiac issues, could not be easily excluded, if all other etiological factors of pulmonary hypertension would be ruled out (in fact etiology of pulmonary hypertension is a diagnosis by exclusion).
Regarding your pain, it may be musculoskeletal (as it most probably should be), but we have to be careful when excluding other etiologies (as many so called musculoskeletal pains finish to result different disorders (ischemic, pulmonary, digestive, neurological, etc. disorders). Nevertheless, after a year, actually your pain is faded and is not a matter of discussion.
I hope to have been clear, and to have fulfilled your answer expectation.
I remain at your disposal for possible other uncertainties! Greetings! Dr. Iliri
Just relax and follow medical instructions!
Detailed Answer:
Hi again dear XXXX!
First, I would like to explain that pulmonary hypertension and pulmonary arterial hypertension in daily clinical practice means the same thing (there exists also venous pulmonary hypertension especially in left heart dysfunctions, but as this consequently leads to arterial pulmonary hypertension it has the same meaning, just different etiologies).
I am exactly saying that based on your last ECHO report, you result with an increased arterial pulmonary pressure (normal PAP is 15 - 30 mmHg, instead of your 58 mmHg) ; that is, you have pulmonary artery hypertension. Don't panic!
As, I explained you above, it is necessary to perform a differential diagnosis, to exclude possible causes (anorectics therapy among them).
I hope that when you will perform the next cardiac ultrasound, that increased pulmonary arterial hypertension will be decreased (???!!), but I am afraid it is going to persist.
So, if pulmonary hypertension is confirmed by repeated ECHO, then the above mentioned advices are necessary to be followed.
Anorectics adverse side effects in regards of your cardiac issues, could not be easily excluded, if all other etiological factors of pulmonary hypertension would be ruled out (in fact etiology of pulmonary hypertension is a diagnosis by exclusion).
Regarding your pain, it may be musculoskeletal (as it most probably should be), but we have to be careful when excluding other etiologies (as many so called musculoskeletal pains finish to result different disorders (ischemic, pulmonary, digestive, neurological, etc. disorders). Nevertheless, after a year, actually your pain is faded and is not a matter of discussion.
I hope to have been clear, and to have fulfilled your answer expectation.
I remain at your disposal for possible other uncertainties! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So PH can be managed you are saying?
I read PAH is rare, like 1 or 2 per million. Is that the kind that is uncurable ? I read PAH means pulmonary arterial hypertension is a disease of the blood vessel of the lungs meaning these vessels have changed causing the elevation in pressure. Whereas in PH it is simply an elevation in the pressure in the arteries of the lungs,other diseases like sleep apnea, and diseases of the left heart can cause pressure in the pulmonary arteries to rise, but this does not mean you have PAH.
What is done for PH and can it improve?
THX
I read PAH is rare, like 1 or 2 per million. Is that the kind that is uncurable ? I read PAH means pulmonary arterial hypertension is a disease of the blood vessel of the lungs meaning these vessels have changed causing the elevation in pressure. Whereas in PH it is simply an elevation in the pressure in the arteries of the lungs,other diseases like sleep apnea, and diseases of the left heart can cause pressure in the pulmonary arteries to rise, but this does not mean you have PAH.
What is done for PH and can it improve?
THX
Brief Answer:
You are right! Several etiologies should be differentiated.
Detailed Answer:
Hi XXXX!
I am glad to discuss with such a medically informed person like you.
Before drawing to prognostic conclusions, it is better to wait the follow up results, and if pulmonary artery hypertension will persist, then it belongs to the differential diagnosis work up to state whether we are in front of a primary or secondary pulmonary hypertension.
My previous recommendation at the beginning of out thread gives important clues of the main suspected etiological factors to consider, and how it can be dealt with.
Pulmonary arterial hypertension is treatable, but with different prognostic outcomes. Primary pulmonary hypertension though rare, shows a more reserved prognosis.
I would recommend you relaxing and wait for your doctor scheduled follow up.
I hope that our thread have been of some help providing you important clues to discuss with your attending doctor.
If you have any other features to discuss upon, feel free to talk to me!
Regards,
Dr. Iliri
You are right! Several etiologies should be differentiated.
Detailed Answer:
Hi XXXX!
I am glad to discuss with such a medically informed person like you.
Before drawing to prognostic conclusions, it is better to wait the follow up results, and if pulmonary artery hypertension will persist, then it belongs to the differential diagnosis work up to state whether we are in front of a primary or secondary pulmonary hypertension.
My previous recommendation at the beginning of out thread gives important clues of the main suspected etiological factors to consider, and how it can be dealt with.
Pulmonary arterial hypertension is treatable, but with different prognostic outcomes. Primary pulmonary hypertension though rare, shows a more reserved prognosis.
I would recommend you relaxing and wait for your doctor scheduled follow up.
I hope that our thread have been of some help providing you important clues to discuss with your attending doctor.
If you have any other features to discuss upon, feel free to talk to me!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am still confused, Dr. I have NO symptoms, I feel great, I have lost weight and now weigh 126.
IF I have PH, not PAH~~~ is that something I can live with for a long time? What if no cause is found for it? Then what is done?
I am just so terrified from all I have read n the internet with 3 yr survival rates, etc. As I understand it, true PAH is the really bad one and PH affects millions of people. Is that right?
Thank you. Right now I am in PANIC mode.
IF I have PH, not PAH~~~ is that something I can live with for a long time? What if no cause is found for it? Then what is done?
I am just so terrified from all I have read n the internet with 3 yr survival rates, etc. As I understand it, true PAH is the really bad one and PH affects millions of people. Is that right?
Thank you. Right now I am in PANIC mode.
Brief Answer:
No rational reason to be in panic!
Detailed Answer:
Hello again, dear XXXXXXX
Do not panic.
Primary pulmonary hypertension is quite rare, and I don't believe that it is your case.
As you are perfectly in normal clinical condition, you don't have to worry too much for that Echo finding.
You don't have to rely too much on that confusing internet information. You have to trust more your virtual doctor (that's me), but you have to trust above all the others your attending physician, who is in close touch with your complaints and your reality.
I tried to explain some main possibilities, after your request. But I didn't mean to get you more in panic.
Your life expectancy seems to be similar to the other healthy normal persons.
The only thing to take into consideration is a regular medical follow up.
Hope to have relieved your anxiety!
Best wishes,
Dr. Iliri
No rational reason to be in panic!
Detailed Answer:
Hello again, dear XXXXXXX
Do not panic.
Primary pulmonary hypertension is quite rare, and I don't believe that it is your case.
As you are perfectly in normal clinical condition, you don't have to worry too much for that Echo finding.
You don't have to rely too much on that confusing internet information. You have to trust more your virtual doctor (that's me), but you have to trust above all the others your attending physician, who is in close touch with your complaints and your reality.
I tried to explain some main possibilities, after your request. But I didn't mean to get you more in panic.
Your life expectancy seems to be similar to the other healthy normal persons.
The only thing to take into consideration is a regular medical follow up.
Hope to have relieved your anxiety!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Ilir, Sorry to bother you again. I have been trying all day to process what you told me, but I fear I am still terrified. I was looking over things I printed off and it mentions Idiopathic PH and says since there is no cause it is fatal in 3 yrs. I am so confused as to PH, PAD, PVD, etc, my head is swimming. I know no cause other than taking diet pills all those yrs ago would have been the reason.
Given what you have read on my results is it possible to have PH and it not be fatal? I know u said I have life expectancy of "other healthy, normal persons". But all the web info seems to point to early and painful death.
I am in tears and have no where to turn. I cannot get through to my cardiologist.
I read on the XXXXXXX Heart Institute, that PAH is "the serious life threatening condition" one. It sounded like PH seems more like a chronic disease. Am I nuts or what? I cannot seem to grasp what I may have. PLEASE help me.
THX!!!
Given what you have read on my results is it possible to have PH and it not be fatal? I know u said I have life expectancy of "other healthy, normal persons". But all the web info seems to point to early and painful death.
I am in tears and have no where to turn. I cannot get through to my cardiologist.
I read on the XXXXXXX Heart Institute, that PAH is "the serious life threatening condition" one. It sounded like PH seems more like a chronic disease. Am I nuts or what? I cannot seem to grasp what I may have. PLEASE help me.
THX!!!
Brief Answer:
No sufficient medical evidence to support those conclusions.
Detailed Answer:
Dear XXXX!
I would like to explain that during our thread I have tried to focus only on pulmonary artery pressure value.
I didn't mean you are suffering from idiopathic PAH, as we haven't clinical data to speculate on that issue.
So, just relax!
It's only an echo measurement, and can't be used to draw definite conclusions. It is important an echocardiographic follow up to identify the trend of PASP (pulmonary artery systolic pressure).
As your doctor wrote on medical report a cardiac ultrasound after 2 months will be helpful to decide if further investigation is necessary.
You are actually clibically normal; and there is no reason to be so anxious.
At the end, there are many cases of echo inaccuracies. That's another reason to repeat that echo.
Please, just stop surfing that information on the web, as it may be so confusing.
I wish you are going to control your anxiety and feel better!
I wish you good health!
Regards,
Dr.Iliri
No sufficient medical evidence to support those conclusions.
Detailed Answer:
Dear XXXX!
I would like to explain that during our thread I have tried to focus only on pulmonary artery pressure value.
I didn't mean you are suffering from idiopathic PAH, as we haven't clinical data to speculate on that issue.
So, just relax!
It's only an echo measurement, and can't be used to draw definite conclusions. It is important an echocardiographic follow up to identify the trend of PASP (pulmonary artery systolic pressure).
As your doctor wrote on medical report a cardiac ultrasound after 2 months will be helpful to decide if further investigation is necessary.
You are actually clibically normal; and there is no reason to be so anxious.
At the end, there are many cases of echo inaccuracies. That's another reason to repeat that echo.
Please, just stop surfing that information on the web, as it may be so confusing.
I wish you are going to control your anxiety and feel better!
I wish you good health!
Regards,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. I wish you were a Doctor that I could actually have an apt with. U are reassuring.
So, I guess you are saying I really to need to chill.
Am I correct in presuming that IF I have PH, it is manageable and not fatal?
THANK YOU! Pls know I am not doubting you at all and I am not a hypochondriac, but for some reason this has me in a tailspin. I guess anything heart related is just so serious and I had NEVER heard of HP before this going on.
So, I guess you are saying I really to need to chill.
Am I correct in presuming that IF I have PH, it is manageable and not fatal?
THANK YOU! Pls know I am not doubting you at all and I am not a hypochondriac, but for some reason this has me in a tailspin. I guess anything heart related is just so serious and I had NEVER heard of HP before this going on.
Brief Answer:
Primary PH disorder is quite rare and impossible at your age.
Detailed Answer:
Hi, dear XXXXXXX
I would like to reassure you what I mentioned before, that between a single increased pulmonary artery pressure value and a PH disorder is really a very big difference (as there are many interfering and confounding factors).
You are in perfectly good conditions and nothing worse is expected to happen.
So, there is no need to worry or talk anxiously over such an unproven hypothesis.
I hope you are going to calm down and stop thinking of primary PH disorder, (which is quite rare and impossible at your age).
Best wishes,
Dr. Iliri
Primary PH disorder is quite rare and impossible at your age.
Detailed Answer:
Hi, dear XXXXXXX
I would like to reassure you what I mentioned before, that between a single increased pulmonary artery pressure value and a PH disorder is really a very big difference (as there are many interfering and confounding factors).
You are in perfectly good conditions and nothing worse is expected to happen.
So, there is no need to worry or talk anxiously over such an unproven hypothesis.
I hope you are going to calm down and stop thinking of primary PH disorder, (which is quite rare and impossible at your age).
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr Illiri,
I am back with questions. I had my echo that was scheduled for Oct moved up and had it 8-21-15. Got results 8-31-15. My cardiologist did not give me a copy of the new echo, but here is what he said:
The pressure on echo report was 48, but HE estimates are really down to between 30-38 ( I think, maybe 35 ?). He said the echo had ONE at 40 but he could not see it.
There was "trivial pericardial effusion, almost not worth mentioning and nothing to be concerned about" May be a fluke??
EF 70-75%.
( Do not know if this is important but when tech was doing the echo he said I had some PV's)
Small or minor left heart enlargement.
Moderate tricuspid regurgitation ~but he thinks it is mild.
Minor mitral valve leakage of no worry.
I asked if he thought I had PH and he said he is not convinced. He said he reads 1500 echos a year. He said basically I am ok and he will recheck with another echo in one year.
I still do not have any symptoms.
I will hopefully have the actual report soon, but am still worried. I feel like I am a walking time bomb.
I requested the echo copy and am waiting for it and when I get it share with you, But for now what do you think? AM I OK? Is it ok to wait a year?
THANK YOU, you are a great help to me.
I am back with questions. I had my echo that was scheduled for Oct moved up and had it 8-21-15. Got results 8-31-15. My cardiologist did not give me a copy of the new echo, but here is what he said:
The pressure on echo report was 48, but HE estimates are really down to between 30-38 ( I think, maybe 35 ?). He said the echo had ONE at 40 but he could not see it.
There was "trivial pericardial effusion, almost not worth mentioning and nothing to be concerned about" May be a fluke??
EF 70-75%.
( Do not know if this is important but when tech was doing the echo he said I had some PV's)
Small or minor left heart enlargement.
Moderate tricuspid regurgitation ~but he thinks it is mild.
Minor mitral valve leakage of no worry.
I asked if he thought I had PH and he said he is not convinced. He said he reads 1500 echos a year. He said basically I am ok and he will recheck with another echo in one year.
I still do not have any symptoms.
I will hopefully have the actual report soon, but am still worried. I feel like I am a walking time bomb.
I requested the echo copy and am waiting for it and when I get it share with you, But for now what do you think? AM I OK? Is it ok to wait a year?
THANK YOU, you are a great help to me.
Brief Answer:
You are just a healthy woman!
Detailed Answer:
Hello again, dear XXXX!
I am glad to confirm you that your latest cardiac ultrasound looks quite OK!
That is, a perfect LVEF, no valvular dysfunctions, no significant pericardial effusion, and furthermore a PAP 30 - 38 mmHg is quite fine.
So, relax dear XXXX!
You are not at risk of any serious cardiac complications, and trusting the preliminary conclusions, just a yearly echo follow up is sufficient (as your doctor has advised).
I will be happy to review your written echo report and definitely conclude there is nothing to worry about.
I am waiting for your echo report; meanwhile I advise you to enjoy your well-being and don't think of any health issue at all.
You are just a healthy woman!
Best regards,
Dr. Iliri
You are just a healthy woman!
Detailed Answer:
Hello again, dear XXXX!
I am glad to confirm you that your latest cardiac ultrasound looks quite OK!
That is, a perfect LVEF, no valvular dysfunctions, no significant pericardial effusion, and furthermore a PAP 30 - 38 mmHg is quite fine.
So, relax dear XXXX!
You are not at risk of any serious cardiac complications, and trusting the preliminary conclusions, just a yearly echo follow up is sufficient (as your doctor has advised).
I will be happy to review your written echo report and definitely conclude there is nothing to worry about.
I am waiting for your echo report; meanwhile I advise you to enjoy your well-being and don't think of any health issue at all.
You are just a healthy woman!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr,
I just uploaded my latest echo. But note at top it says indication for exam--Chronic pulmonary hypertension. THAT scares me sooooooo.
What do u think? I am worried about:
Left Atrium, normal in size, visually at least mildly enlarged. WHAT does that indicate/mean? Note it measured 3.6 on this years echo and 3.7 on last years, so how is that larger?
Left ventricle, normal in size and function. Left ventricular wall thickness and wall motion is normal. Grade 2 diastolic dysfunction noted. MEANING?
Right Atrium, perhaps mildly enlarged. ????
Tricuspid Valve, Anatomically normal with moderate insufficiency and mild elevation of estimated pulmonary artery pressure. DOES that mean Primary or secondary pulmonary hypertension?
Pulmonic Valve, trace pulmonic insufficiency but no stenosis.
I am confused because my Dr said he has to say pulmonary hypertension so insurance will pay. IS that normal? Do I have pulmonary hypertension?
Is it good my overall number went down? My Dr said the he thinks actual pressure was 30-38, (maybe he said 30-35, I cannot recall) It concerns me that my pressure is high.
If I do not have PH why is my number 48 on the echo? My Dr said the echo reported one reading of 40 but he could not see it. Do they have to take the biggest number and estimate from that? I asked if I needed right heart XXXXXXX and he said no. I THINK he said most of my pressures were in 20s but NOT sure, I was so nervous.
I asked for the office visit notes, but it takes longer to get them. When I do, I will send to you.
This is ruining any life I may have left. I am confused, I cannot eat or sleep and am so afraid of dying from this horrible disease. Am I going to progress to the awful PH ?? PLEASE give me answers.
THX!!
I just uploaded my latest echo. But note at top it says indication for exam--Chronic pulmonary hypertension. THAT scares me sooooooo.
What do u think? I am worried about:
Left Atrium, normal in size, visually at least mildly enlarged. WHAT does that indicate/mean? Note it measured 3.6 on this years echo and 3.7 on last years, so how is that larger?
Left ventricle, normal in size and function. Left ventricular wall thickness and wall motion is normal. Grade 2 diastolic dysfunction noted. MEANING?
Right Atrium, perhaps mildly enlarged. ????
Tricuspid Valve, Anatomically normal with moderate insufficiency and mild elevation of estimated pulmonary artery pressure. DOES that mean Primary or secondary pulmonary hypertension?
Pulmonic Valve, trace pulmonic insufficiency but no stenosis.
I am confused because my Dr said he has to say pulmonary hypertension so insurance will pay. IS that normal? Do I have pulmonary hypertension?
Is it good my overall number went down? My Dr said the he thinks actual pressure was 30-38, (maybe he said 30-35, I cannot recall) It concerns me that my pressure is high.
If I do not have PH why is my number 48 on the echo? My Dr said the echo reported one reading of 40 but he could not see it. Do they have to take the biggest number and estimate from that? I asked if I needed right heart XXXXXXX and he said no. I THINK he said most of my pressures were in 20s but NOT sure, I was so nervous.
I asked for the office visit notes, but it takes longer to get them. When I do, I will send to you.
This is ruining any life I may have left. I am confused, I cannot eat or sleep and am so afraid of dying from this horrible disease. Am I going to progress to the awful PH ?? PLEASE give me answers.
THX!!
Brief Answer:
One thing is quite sure: you are not going to die from PH.
Detailed Answer:
Hi XXXX!
I passed carefully through you last cardiac ultrasound report (after reviewing again your penultimate echo).
Let me explain each uncertainty:
First, I would like to explain that “indication for exam” is just a justification for performing the required follow up. It doesn’t predict a definite and approved diagnosis.
Regarding your left atrium dimension, both values (3.6 & 3.7 cm) are normal. The noticed difference doesn’t mean a real change. It’s just explained by measurement variability (inter-observer and intra-observer), and is dependent on examiner accuracy.
Referred grade 2 diastolic dysfunction, doesn’t seem to be a logical conclusion, as besides DT 223ms (which is quite normal for your age), there is no estimation through tissue Doppler investigation to properly differentiate a real pseudo-normal LV filling pattern (or grade 2 diastolic dysfunction).
From the other side, even if we hold true a grade 2 diastolic dysfunction, it couldn’t explain why pulmonary artery pressure is decreased compared to penultimate echo (where diastolic dysfunction is absent).
In such case pulmonary artery pressure should have been increased.
So, I believe there are misinterpretations regarding LV diastolic function (personally I believe the underlying conclusions are inaccurate).
This brings me to the idea you shouldn’t worry too much about such conclusions!
“Right Atrium, perhaps mildly enlarged” is just a speculation, as it is quite possible by means of echo to differentiate if it is really dilated or not (exact chamber measurement).
I would like to reassure that a primary pulmonary hypertension is quite impossible at your age, accounting for your clinically normal condition. If it were present, it would have appeared in a much younger age and produced significant cardiac changes *which in fact are absent).
So, I totally exclude a primary pulmonary hypertension.
Your echo reveals a TRPG 40 mmHg. That is tricuspid gradient, which is used for PAP estimation. Based on this, your PAP is less than 50 mmHg.
But, I have my doubts regarding TRPG measurement accuracy. It is important to directly review the echo photos.
Dear XXXXXXX
There are some discrepancies regarding PAP values between several echo reports. I believe this is due to measurement inaccuracies. That’s why you shouldn’t worry about.
Furthermore, your doctor’s comment on insurance issues and his subsequent ponderation on presented PAPs, raise further suspicions on the technician PAP measurements.
My personal opinion is not to worry about this issue, as further cardiac ultrasounds are going to reveal newly different PAP evidence again.
One thing is quite sure: you are not going to die from pulmonary hypertension.
This seems to be logical, facing your actual clinical scenario and cardiac ultrasound report.
Even your doctor thinks so on his report. You just need a yearly echo follow up.
I am sorry about the delayed response (because my actual professional commitment).
Best wishes,
Dr. Iliri
One thing is quite sure: you are not going to die from PH.
Detailed Answer:
Hi XXXX!
I passed carefully through you last cardiac ultrasound report (after reviewing again your penultimate echo).
Let me explain each uncertainty:
First, I would like to explain that “indication for exam” is just a justification for performing the required follow up. It doesn’t predict a definite and approved diagnosis.
Regarding your left atrium dimension, both values (3.6 & 3.7 cm) are normal. The noticed difference doesn’t mean a real change. It’s just explained by measurement variability (inter-observer and intra-observer), and is dependent on examiner accuracy.
Referred grade 2 diastolic dysfunction, doesn’t seem to be a logical conclusion, as besides DT 223ms (which is quite normal for your age), there is no estimation through tissue Doppler investigation to properly differentiate a real pseudo-normal LV filling pattern (or grade 2 diastolic dysfunction).
From the other side, even if we hold true a grade 2 diastolic dysfunction, it couldn’t explain why pulmonary artery pressure is decreased compared to penultimate echo (where diastolic dysfunction is absent).
In such case pulmonary artery pressure should have been increased.
So, I believe there are misinterpretations regarding LV diastolic function (personally I believe the underlying conclusions are inaccurate).
This brings me to the idea you shouldn’t worry too much about such conclusions!
“Right Atrium, perhaps mildly enlarged” is just a speculation, as it is quite possible by means of echo to differentiate if it is really dilated or not (exact chamber measurement).
I would like to reassure that a primary pulmonary hypertension is quite impossible at your age, accounting for your clinically normal condition. If it were present, it would have appeared in a much younger age and produced significant cardiac changes *which in fact are absent).
So, I totally exclude a primary pulmonary hypertension.
Your echo reveals a TRPG 40 mmHg. That is tricuspid gradient, which is used for PAP estimation. Based on this, your PAP is less than 50 mmHg.
But, I have my doubts regarding TRPG measurement accuracy. It is important to directly review the echo photos.
Dear XXXXXXX
There are some discrepancies regarding PAP values between several echo reports. I believe this is due to measurement inaccuracies. That’s why you shouldn’t worry about.
Furthermore, your doctor’s comment on insurance issues and his subsequent ponderation on presented PAPs, raise further suspicions on the technician PAP measurements.
My personal opinion is not to worry about this issue, as further cardiac ultrasounds are going to reveal newly different PAP evidence again.
One thing is quite sure: you are not going to die from pulmonary hypertension.
This seems to be logical, facing your actual clinical scenario and cardiac ultrasound report.
Even your doctor thinks so on his report. You just need a yearly echo follow up.
I am sorry about the delayed response (because my actual professional commitment).
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi DR, Sorry for my delay. I have been thinking about your answer. It is giving me hope,
1. Can u further explain the grade 2 diastolic function? I am confused. If it were dangerous would my Dr have done something about it? He never mentioned it.
2. Also about the tricuspid regurgitation.. does something need to be done?
3. IS the 48 number based off the one 40 the technician saw? Or it is estimated? I am not clear on how they get it.
4. Did you get to read my Dr.'s clinical notes? I uploaded them after my echo because I did not have them til later in the day.
5, Finally, do I pulmonary hypertension? If I do, how long can I expect to live? I am confused on this. I have been trying to stop reading internet info, but all that I have read has so confused me. I know u are an experienced and knowledgeable cardiologist and I am relying on answers from you instead.
6. I saw where you did a paper/talk on Diuretic Heart Failure at a European conference. Anyway I assume that is you.
Please help me put this issue to rest before I am crazy!!
Thank you and GOD BLESS U!!!!
1. Can u further explain the grade 2 diastolic function? I am confused. If it were dangerous would my Dr have done something about it? He never mentioned it.
2. Also about the tricuspid regurgitation.. does something need to be done?
3. IS the 48 number based off the one 40 the technician saw? Or it is estimated? I am not clear on how they get it.
4. Did you get to read my Dr.'s clinical notes? I uploaded them after my echo because I did not have them til later in the day.
5, Finally, do I pulmonary hypertension? If I do, how long can I expect to live? I am confused on this. I have been trying to stop reading internet info, but all that I have read has so confused me. I know u are an experienced and knowledgeable cardiologist and I am relying on answers from you instead.
6. I saw where you did a paper/talk on Diuretic Heart Failure at a European conference. Anyway I assume that is you.
Please help me put this issue to rest before I am crazy!!
Thank you and GOD BLESS U!!!!
Brief Answer:
I would explain as follows:
Detailed Answer:
Hi again, XXXX!
1. As I have explained you before, I am not sure you have really grade 2 diastolic dysfunction, as the only parameter I saw in your echo report DT (deceleration time) is compatible (normal) with your age.
Theoretically speaking, grade 2 diastolic dysfunction (or left ventricular pseudo-normal filling pattern) expresses a condition (measured by echo), where left ventricle lacks adequate compliance during diastole leading to increased left ventricular end-diastolic pressure. This pattern resembles a normal LV filling pattern (E/A ratio), but shows a decreased DT; also an altered E/E' ratio (which wasn't reflected on your last echo report). Grade 2 diastolic dysfunction, if it was really present, would explain your increased PAP values. I think that a more serious follow up echo should better address this issue.
2. Mild tricuspid regurgitation is frequently seen in normal healthy individuals. Your last echo reviewed by your doctor shows a mild up to moderate tricuspid regurgitation. Facing this pattern, there is nothing to worry about, it is just recommended performing periodic echo follow ups.
3. Your last echo reveals a TRPG (tricuspid regurgitation peak gradient) of 40 mmHg. TRPG is used to measure sPAP (systolic pulmonary artery pressure) by adding the estimated right atrial pressure (3 - 8 mmHg) using the formula: sPAP=TRPG+RAP.
4. I reviewed your Dr's notes during my last response, and I agree with his conclusion; there is no clear evidence you suffer from chronic pulmonary hypertension (no right chamber dilation, no suggestive clinical signs, etc). A regular echo follow up will elucidate further these topics.
5. I would like to explain that pulmonary hypertension is present when mean pulmonary artery pressure exceeds 25 mm Hg at rest. Mean pulmonary artery pressure (mPAP) should not be confused with systolic pulmonary artery pressure (sPAP), which is reported on cardiac ultrasound. mPAP is measured by the formula: mPAP = 0.61•sPAP + 2. Facing your last sPAP of around 45, it is expected a mPAP of around 29 mmHg, so only slightly elevated above the cut off 25 mmHg. Coming to this point, it is more prudent not to draw premature conclusion on a present pulmonary hypertension, but to perform a meticulous echo follow up instead. That's my opinion.
6. My fields of professional interest comprise critically ill cardiac patients, especially acute heart syndromes, and consequently also pulmonary hypertension issue. So, I think that my opinion will be helpful in clarifying your uncertainties regarding these issues.
My best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hi again, XXXX!
1. As I have explained you before, I am not sure you have really grade 2 diastolic dysfunction, as the only parameter I saw in your echo report DT (deceleration time) is compatible (normal) with your age.
Theoretically speaking, grade 2 diastolic dysfunction (or left ventricular pseudo-normal filling pattern) expresses a condition (measured by echo), where left ventricle lacks adequate compliance during diastole leading to increased left ventricular end-diastolic pressure. This pattern resembles a normal LV filling pattern (E/A ratio), but shows a decreased DT; also an altered E/E' ratio (which wasn't reflected on your last echo report). Grade 2 diastolic dysfunction, if it was really present, would explain your increased PAP values. I think that a more serious follow up echo should better address this issue.
2. Mild tricuspid regurgitation is frequently seen in normal healthy individuals. Your last echo reviewed by your doctor shows a mild up to moderate tricuspid regurgitation. Facing this pattern, there is nothing to worry about, it is just recommended performing periodic echo follow ups.
3. Your last echo reveals a TRPG (tricuspid regurgitation peak gradient) of 40 mmHg. TRPG is used to measure sPAP (systolic pulmonary artery pressure) by adding the estimated right atrial pressure (3 - 8 mmHg) using the formula: sPAP=TRPG+RAP.
4. I reviewed your Dr's notes during my last response, and I agree with his conclusion; there is no clear evidence you suffer from chronic pulmonary hypertension (no right chamber dilation, no suggestive clinical signs, etc). A regular echo follow up will elucidate further these topics.
5. I would like to explain that pulmonary hypertension is present when mean pulmonary artery pressure exceeds 25 mm Hg at rest. Mean pulmonary artery pressure (mPAP) should not be confused with systolic pulmonary artery pressure (sPAP), which is reported on cardiac ultrasound. mPAP is measured by the formula: mPAP = 0.61•sPAP + 2. Facing your last sPAP of around 45, it is expected a mPAP of around 29 mmHg, so only slightly elevated above the cut off 25 mmHg. Coming to this point, it is more prudent not to draw premature conclusion on a present pulmonary hypertension, but to perform a meticulous echo follow up instead. That's my opinion.
6. My fields of professional interest comprise critically ill cardiac patients, especially acute heart syndromes, and consequently also pulmonary hypertension issue. So, I think that my opinion will be helpful in clarifying your uncertainties regarding these issues.
My best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr.
So in regard to all my questions, including the grade 2 diastolic dysfunction,
1. it is your advice to just follow up with another echocardigram in one year? Or did you mean do something about the grade 2 diastolic dgsfunction now?
2. Your conclusion is that I do not have pulmonary hypertention, correct?
I am so sick of being worried that I have literally gotten sick, stomache ache, nausea, cannot sleep, sweating at night, etc. Do you think that is all brought in by my nerves?
I know I could never have gotten through this without you. Please answer these last questions so I will.be able to put this behind me.
Thank you, God Bless you. I am eternally.greatful for your advice.
So in regard to all my questions, including the grade 2 diastolic dysfunction,
1. it is your advice to just follow up with another echocardigram in one year? Or did you mean do something about the grade 2 diastolic dgsfunction now?
2. Your conclusion is that I do not have pulmonary hypertention, correct?
I am so sick of being worried that I have literally gotten sick, stomache ache, nausea, cannot sleep, sweating at night, etc. Do you think that is all brought in by my nerves?
I know I could never have gotten through this without you. Please answer these last questions so I will.be able to put this behind me.
Thank you, God Bless you. I am eternally.greatful for your advice.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hi again dear XXXXXXX
I am glad to have been helpful for you!
I think that all the above history has raised excessive anxiety and has affected the way how your mind is thinking and feeling.
I would like to explain that regarding grade 2 diastolic dysfunction, we haven't sufficient evidence to support such a conclusion.
So and an echo follow up is necessary to address this issue (as your doctor has advised).
Your recent cardiac ultrasounds has reveled inconsistently mild elevation of PAP.
So as I have explained you before only a meticulous echo follow up would clarify the real PAP trends.
For the moment no serious disorder could be confirmed with your pulmonary blood circulation.
If you have further uncertainties, feel free to ask me directly on this address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
I will be at your disposal whenever you need!
Best regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hi again dear XXXXXXX
I am glad to have been helpful for you!
I think that all the above history has raised excessive anxiety and has affected the way how your mind is thinking and feeling.
I would like to explain that regarding grade 2 diastolic dysfunction, we haven't sufficient evidence to support such a conclusion.
So and an echo follow up is necessary to address this issue (as your doctor has advised).
Your recent cardiac ultrasounds has reveled inconsistently mild elevation of PAP.
So as I have explained you before only a meticulous echo follow up would clarify the real PAP trends.
For the moment no serious disorder could be confirmed with your pulmonary blood circulation.
If you have further uncertainties, feel free to ask me directly on this address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
I will be at your disposal whenever you need!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr.
I appreciate your time and answers. One last question,is this meticulous follow up echo the same thing as the one year echo my Dr recommended? Or is a meticulous echo different?
All I want to know is that I am.ok and I can wait the oneyear for my echo.
Thank you so much.
I also meant is the one year follow up echo advised for the grade 2 distolic dysfunction also or is meticulous serious echo some other kind?
I appreciate your time and answers. One last question,is this meticulous follow up echo the same thing as the one year echo my Dr recommended? Or is a meticulous echo different?
All I want to know is that I am.ok and I can wait the oneyear for my echo.
Thank you so much.
I also meant is the one year follow up echo advised for the grade 2 distolic dysfunction also or is meticulous serious echo some other kind?
Brief Answer:
Yearly echo follow up is advisable.
Detailed Answer:
Dear XXXX!
You should follow your attending doctor instruction for a yearly careful echo follow up.
Regards!
Yearly echo follow up is advisable.
Detailed Answer:
Dear XXXX!
You should follow your attending doctor instruction for a yearly careful echo follow up.
Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. I promise, this is my last question.Your saying meticulous or serious just means my yearly follow up echo and not some different kind of echo, correct?
I did not know if meticulous ir serious were special medical kinds??
Thank you! You have been a Godsend to me and I appreciate your patience. You can be sure u have 5 stars!!!
PS same for grade 2 diastolic dysfunction also? Just 1 yr follow up echo, correct?
THX
I did not know if meticulous ir serious were special medical kinds??
Thank you! You have been a Godsend to me and I appreciate your patience. You can be sure u have 5 stars!!!
PS same for grade 2 diastolic dysfunction also? Just 1 yr follow up echo, correct?
THX
Brief Answer:
Please review once more our thread!
Detailed Answer:
Dear XXXX!
I have tried to be explicit when explaining you all those echo details (including hypothetical grade 2 diastolic dysfunction) you have asked.
As I said you before, there are not sufficient evidence to support that echo conclusion, I personally don't believe it is present.
Please, review all the long thread we have above!
So, yearly echo follow up!
With "meticulous" I mean a careful echo exam to include also tissue Doppler investigation (not prescribed on the last echo report) and pulmonary artery pressure (which should be reviewed with repeated measurements to assure the most accurate conclusion).
That's my opinion.
Best wishes,
Dr. Iliri
Please review once more our thread!
Detailed Answer:
Dear XXXX!
I have tried to be explicit when explaining you all those echo details (including hypothetical grade 2 diastolic dysfunction) you have asked.
As I said you before, there are not sufficient evidence to support that echo conclusion, I personally don't believe it is present.
Please, review all the long thread we have above!
So, yearly echo follow up!
With "meticulous" I mean a careful echo exam to include also tissue Doppler investigation (not prescribed on the last echo report) and pulmonary artery pressure (which should be reviewed with repeated measurements to assure the most accurate conclusion).
That's my opinion.
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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