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Pulmonary Hypertension

Pulmonay hypertention

11/28/2005

Question:

I was told in 1998 that I had pulmonay hypertension after a echo. I had further test vq lung scan and doppler on leg that showed no clots, I was told therefore that meant I had primary pulmonary hypertension since they could not find any other cause. I was sent to a cardiologist for a heart cath where he said I did NOT have pulmonary hyptension, just that I was simply fat and out of shape. I had just recently lost close to 40 lbs when this all occured. a few months later I was discovered to have graves diease and after this was taken care of by RAI, my shortness of breath, rapid heart rate, etc all seemed to go away, until this week 7 years later. I never had further cardiac testing since the cardiologist said my echo diagnosis was wrong. I had gastric bypass about 4 months ago in order to lose weight. I had lost about 42 lbs up until a week ago when these symptoms started , same as before, shortness of breath, rapid heart rate, nausea, abd pain and increase in menses, I rapidly lost another 8 pounds and stay so nauseased that I cannot eat much. My doc says I am in metobolic acidosis and she doesn`t know why, she ordered a echo and a holter monitor. I am still waiting for the results of both, however, I work for the hospital where the echo was done and the tech told me it looked about like the same as when I was diagnosed in 1998. So this means I am going to again be diagnoised with pulmonary hypertension and probably primary again because I don`t belive they will find any other problems causing it. My question; I take synthroid after having my grave diease treated with RAI. Apparently I should have had my dose decreased while I was losing weight and didn`t do so, these symptoms started when my TSH was close to nothing, about the same when my graves disease was discovered. Both times I suffered from the shortness of breath and chest pain is when I recently dropped a lot of weight, the first time from my thyroid and the second time from my Weight loss surgery. Could their be any connection to the two incidents of rapid weight loss with the pulmonary hypertension diagosis? I am 39 y/o. Can the pulmonary hypertenion be fixed and reversed or at lease decreased? I had the surgery to improved my health and it did decrease my blood pressure along with my resting heart rate(until last week) to normal. Ii am concerned that with all the nausea I cannot get more than 500 to 600 calories in a day. The shortness of breath is slowly getting better today and so are the chest pains. I have had nausea and abd pain every since my surgery that my PCP treated with reglan which it seemed to work but since she wasn`t sure what was going on, she took me back off the reglan for now and that is why I am having so much nausea. I just want to get well and find out what I need to do so. Can you tell me what all I need to make sure they test for to find the cause of the hypertension diagnois? I believe I would not be alive today if I truly had untreated primary pulmonary hypertension since 1998, this makes me think mine is seconary, but to what and why is their always rapid weight loss involved? I thought I was just having a reaction to the overdose of thyroid medicine but now I am confued and very concered as well as my family. ANY information you can provide to help me get an acurate diagnonis and treatment would be greatly appreciated. Thanks in advance for your time.

Answer:

The symptoms of shortness of breath and rapid heart rate are symptoms of pulmonary hypertension, but it seems like they were related to your thyroid disorder. The nausea and abdominal pain are likely from the gastric bypass surgery. The echo is a screening tool for pulmonary hypertension, and the diagnosis is confirmed by actually measuring the pressures by the cardiac catheterization.  If your cardiologist did not find increased pulmonary arterial pressures on the cardiac catheterization then it is very unlikely that you had pulmonary hypertension in 1998.

Some people with Graves Disease may develop pulmonary hypertension which frequently resolves once the thyroid disorder is treated. Unfortunately the symptoms of pulmonary hypertension are very nonspecific, i.e shortness of breath, chest tightness, leg swelling - which may occur in many other conditions.

I would recommend following up with your endocrinologist to see if the synthroid needs to be adjusted; and check on the echo report.

For more information:

Go to the Pulmonary Hypertension health topic, where you can:

Response by:

Namita   Sood, MD, FCCP Namita Sood, MD, FCCP
Associate Professor of Pulmonary, Critical Care & Sleep
College of Medicine
The Ohio State University