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Monday, December 9, 2013
High Blood Pressure
OK to exercise?
I am a 41 year old Caucasian female (non-smoker, weight 143 lbs, height 5 feet 5 inches ), who recently underwent a physical.
During this examination and resulting blood tests it was discovered that while my BP is normal, I suffer from high cholesterol (LDL: 150 HDL: 50 Total Cholesterol 215), and hypothyroidism (TSH 7.54). I have now been taking 0.25 micrograms of levothyroxin for approximately two weeks.
A couple of days ago, I also had an echocardiogram as my GP heard a distinct clicking noise when listening to my heart. The cardiologist`s findings are below.
Regarding the cardiologists findings`, is it safe to exercise?
I do brisk walking (4 - 4.25 mph in hilly country) 5 times a week for an hour to two hours each session. Typically my average heart rate during these sessions is around 75 - 79% of my estimated max of 185 (226 - my age), though it climbs higher in the hills.
Should I slow down a bit on the hilly parts? Should I slow down in general and keep my heart rate at a lower level while walking?
Also regarding the elevated right ventricular systolic pressure... I had a good case of "white coat syndrome" the day of my exam.. Could this have caused these particular numbers to be high?
2D DOPPLER EXAMINATION FINDINGS
Left Ventricle: The Left ventricle is normal in size. Left ventricular systolic function is normal.
Mitral Valve: The mitral leaflets appear thickened, hooded and/or redundant, consistent with myxomatous degeneration. There is trace mitral regurgitation.
Tricuspid Valve: There is mild to moderate tricuspid regurgitation. Right ventricular systolic pressure is elevated at 30 - 40mm HG.
MMode/2D Measurements & Calculations:
IVSd: 0.83 cm LVIDd: 4.2 cm LVIDs: 2.6 cm LVPWd: 0.78 cm FS: 39% EDV(Teich): 80 ml ESV(Teich): 24 ml EF(Teich) 70% Ao Root Diam: 3.4 cm Ao Root Area: 9.2 cm2 ACS: 1.8 cm LA dimension: 2.9 cm
Doppler Measurements & Calculations:
MV E max vel: 81 cm/sec MV A max vel: 100 cm/sec MV E/A: 0.81 Ao V2 Max: 156 cm/sec Ao max PG: 9.7 mm HG LV max PG: 8.3 mm HG LV V1 max: 144 cm/sec TR max vel: 243 cm/sec TR max PG: 24 mm HG RVSP(TR): 34 mm HG
Your echocardiogram shows two abnormalities, which probably are not related to each other:
1) You have mitral valve prolapse (MVP), also called myxomatous degeneration. MVP is a loose or "floppy" mitral valve, which prevents the valve from closing properly during contraction of the left ventricle (systole). This causes the mid-systolic click. It is usually mild and benign, although more severe forms do occur. Most cases of MVP are not associated with other abnormalities.
2) You have some tricuspid insufficiency and elevated right ventricular pressure. That means that you also have elevated pulmonary artery pressure. Pulmonary hypertension can have several causes, but it is probably not related to the MVP.
You will need an evaluation by a cardiologist and possibly a right sided heart catheterization to measure the pulmonary artery pressure and to help determine the cause of the pulmonary hypertension. I would hold off with vigorous exercise until this issue has been clarified. If you have any more questions, make sure to ask your doctor to see if a right sided heart catheterization is right for you.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati