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Tuesday, September 2, 2014
A few questions about pulmonary hypertension; What are the ranges of pressure you are aware of... from normal to the highest you have seen? On a scale of 1-10, how high is a pressure of 75mmhg considered? If I am asymptomatic, at what pressure can I live with without considering invasive medical procedures and / or meds? Is it reasonable to hope the pressure still may go down on its own- it has been 6 months since I was diagnosed with multiple PE`s, treated with heparin and lovinox in the hospital, and now warfarin. Will the pressure in my lungs continue to rise, on warfarin, without any other interventions? Thank you.
Your questions are a bit difficult to address as the information that is available is incomplete. The pressure of 75 obtained from an echocardiogram is an estimation which can be significantly different from the pulmonary artery pressure obtained at cardiac catheterization.
On a heart catheterization, we obtain a systolic (top number) and diastolic (bottom number). Normal might be something in the range of 20/10. The echo number roughly corresponds to the systolic (top number), although in some patients it is significantly higher or lower at the time of catheterization. We get additional information from the catheterization which is very useful including an estimation of the actual function of the heart.
All this being said, a pressure of 75 obtained 6 months after a pulmonary embolism is worrisome and deserves further investigation to some degree. Without the other cath data I can't really give you a sense of how worrisome it is on a 1-10 scale.If you are asymptomatic, then it is possible that the echo is overestimating the pressure and you may well be found to have normal or near normal pressures on heart catheterization and this would be great news. It is also possible that you are more symptomatic than you realize and formal testing of your exercise capacity would be done as part of an evaluation. In the absence of more testing, it is difficult to determine a precise diagnosis or prognosis. If you do have pulmonary hypertension, then it may be related to the pulmonary embolism and may be very treatable with surgery. If you do not have evidence of residual blood clot but still have pulmonary hypertension, then it may be from something else which would require completely different treatment. If you have pulmonary hypertension due to residual blood clot demonstrated many months after the original pulmonary embolism, it is unlikely that this will improve with just anticoagulation and there is a good chance that it will get worse. You may not require surgery or be a candidate for surgery but other medication may be useful. At a minimum, I would recommend seeing a pulmonary hypertension specialist and undergoing at least some testing to determine whether or not you truly have PH and what the cause is.
Douglas W Haden, MD
College of Medicine
The Ohio State University