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Pulmonary Hypertension

Stress Echo Results and PH

07/22/2010

Question:

I AM FEMALE, 57 YEARS OLD. I HAD AN ECHO STRESS B/C OF PALPITATIONS AND THESE ARE THE RESULTS.

Baseline Echo: All walls show normal thickening and endocardial excursion. No regional wall motion abnormalities are noted. Global left ventricular function is normal. The left atrium is top normal in size. There is mild mitral regurgitation. There is mild right ventricular dilation with normal right ventricular systolic function. There is mild tricuspid regurgitation with an estimated right ventricular systolic pressure of 38 mmHg. E wave is 0.9 with an E prime of 0.08 and an E to E prime ratio of 11. An intra-atrial septal aneurysm is noted without left to right shunt noted by color flow Doppler.

Exercise Echo: Post exercise all walls become hyperdynamic. All walls show normal thickening. No regional wall motion abnormalities are noted. Overall left ventricular function is hyperdynamic. Estimated right ventricular systolic pressure rose to 62 mmHg post exercise.

MY CARDIOLOGIST SAID HE BELIEVES IT IS NOT MY HEART AND TO SEE A PULMONOLOGIST. I SAW A PULMONOLOGIST WHO DID A CHEST XRAY (NORMAL) AND PULMONARY FUNCTION TESTS, ALL NORMAL. MY OXYGEN LEVEL WAS 97%. HE TOLD ME TO SCHEDULE FOR A ECHOCARDIOGRAM IN A YEAR. I DON`T HAVE DISTENDED NECK VEINS. I DO HAVE VERY MILD SWELLING MY MY FEET BUT THIS SEEMS TO ONLY HAPPEN IN THE VERY HOT SUMMER MONTHS. DURING THE WINTER I AM FINE. I HAVE HAD SHORTNESS OF BREATH FOR YEARS AND AT SOME POINT EVERY DAY, EITHER AT REST OR WITH ACTIVITY, BUT I CAN DO JUST ABOUT ANYTHING WITH NO PROBLEM. MY PULMONOLOGIST TOLD ME THIS MAY BE ANXIETY.

AT THIS POINT I AM SO TOTALLY STRESSED THAT I AM NOT SURE IF I AM CAUSING MY BREATHING PROBLEMS OR IF IT IS FROM PH. SHOULD I BE CONCERNED IF MY PULMONOLOGIST IS NOT AND WANTS TO WAIT A YEAR? I KNOW MAKING A DIAGNOSIS OF PH IS DIFFICULT. I HAVE NEVER BEEN SO SCARED IN MY ENTIRE LIFE.

Answer:

Echocardiogram is used as a screening test for pulmonary hypertension. That means that sometimes the echo may look abnormal, but the patient may not have pulmonary hypertension and vice a versa. The way a test is interpreted is based on what the patient's symptoms are and what their risk factors are for pulmonary hypertension. The sure way to tell would be to measure the pressures with right heart catheterization. 

I would encourage you to discuss your symptoms, concerns, and the echo results with your pulmonologist.

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