Just Don't Get It

[KimC]

Hi,

As some of you may remember, I was diagnosed with a type of angina due to cardiac failure last February and entered into a NHLB study on female small vessel disease. I started taking an ACE and diuretic and began feeling fewer instances of chest pain, hoping that this meant I was improving.

A recent cath and echo revealed otherwise, and that in fact the RV is mildy dilated and dysfunctional. The news came as a shock. All along we've been watching for LV dilation from the aortic valve disease.

My EF is 50%; the LV is 2.4. So in terms of left-sided size and function, everything's within normal limits. The right side is a different story. From what I've been told, the RV is sensitive and unable to handle a lot of overload without damage.

I'm not a doctor, neither are many of you reading this, but I just don't get it. My pulmo said my lungs only show mild disease, and delegates all the analysis of my diagnosis to my cardiologist.

My primary cardio, Dr. Pepine is on vaca this week, so I've been discussing my test results with my local cardio who isn't as educated about small vessel disease as Pepine but is highly competent.

I -- and again, I'm NOT a doctor -- think the stress on the right side COULD be due to pulmonary arterial narrowing, or PH. This is, afterall, small vessel disease which I have been diagnosed with.

For those of you who are familiar with PH, wouldn't it show up in my PF tests? I know a right heart cath is the gold standard for diagnosing PH, and I could be headed in that direction. When is a right-heart cath is indicated? What kind of questions should I be armed with next week when I speak to Dr. Pepine?

Thanks in advance.

Best,

 

[Harrybaby666]

Pulmonary Artery Pressure...

Pulmonary Artery Pressure...

Kim,
did they tell you what your pulmonary artery pressure was on your last echo? Usually, mine does, however, I would certainly speak with the Pulmonologist on this one. I have read though that right sided heart failure is a complication of PH. You might wanna check out http://www.phassociation.org and hopefully this will help you, but by all means, when you get the chance. check with your pulmonary doctor. I hope this helps you in some way..Take Care, Harrybaby

 

[Yaps]

My hubby has PH, his mean pressures at cath were 58. The cardio and pulmin, did a cath as some meds were not bring stats down. Once they were in they injected meds , the ones which helped are the ones he is on now,(verapramil saved the day,btw). His last echo, showed no increase in pp, he is stable. As long as he takes his meds. Dont know if this helps, but wish you luck, the link Harry gave you is very good, been there for years now..love Yaps

 

[KimC]

Thanks, Harry. I've checked my echoes and none of them even list pulmonary pressures. One cites abnormal right atrial pressure and my RVSP was slightly abnormal back in Dec. '03 (six months postpartum). I was told that it would probably get better over time. Maybe it would have had I been on meds earlier. Who knows.

Goin' to the beach --

 

[KimC]

Thanks, Yaps.

Love,
Kim

 

[Johnny Stephens]

Thanks, Harry. I've checked my echoes and none of them even list pulmonary pressures. One cites abnormal right atrial pressure and my RVSP was slightly abnormal back in Dec. '03 (six months postpartum). I was told that it would probably get better over time. Maybe it would have had I been on meds earlier. Who knows.

Goin' to the beach --

I also recently discovered I have mild RV enlargement, and moderate PH. It was explained to me in the past that in an echo, the pulmonary pressure measurement is extrapolated from other measurements. There is no way to measure it directly in an echo. I was set up for a right-heart cath for my pacemaker anyway, so that was mere coincidence.

My docs *believe* my PH is secondary to severe obstructive sleep apnea, for which I'm just beginning treatment. They predict that if I tolerate the CPAP well, my PH will improve, and therefore my right-heart function will also improve.

 

[Nancy]

Joe's showed up on his echoes for years and his cardiologist at the time, never even mentioned it, not even when it was severe.

Ask your cardiologist specifically what your pressures are and if it indicates any pulmonary hypertension.

Go to the site that Harry mentioned. They are wonderful there.

You are right, if there is any hint of PH, then a right-sided heart cath should be done. But before you do this, if you do have PH, you HAVE to see a specialist in it. Ordinary cards or pulms. don't see enough cases to be able to help you.

There are some very good meds for it now.

Joe is on Tracleer, and his pressures went from the high seventies down to the mid forties, still elevated but much, much better. And he uses no oxygen. He would have died without it.