The Rvsp And Pulmonary Artery Pressure Estimate From Echo Are Not Perfect
Its very important to remember that echocardiography is not an exact science and there are many limitations to measurements obtained. Also multiple numbers such as RVSP are being put in to formulas, so any errors will be greater multiplied. For this reason, . Also, its important that the RVSP value isnt taken in isolation when suggesting a diagnosis of pulmonary hypertension, rather multiple supporting echocardiographic findings should be taken together.
What Are Some Causes Of Elevated Right Ventricular Systolic Pressure
This is split in to primary and secondary causes. Primary pulmonary hypertension is less common than secondary. In primary pulmonary hypertension an underlying cause if often not found for the high pressures in the lungs. In secondary pulmonary hypertension the high pressures are attributed to other causes. The most common cause is;left sided heart failure such as that seen with valvular heart disease like mitral regurgitation or aortic stenosis or congestive heart failure. Other causes include chronic conditions such as sleep apnea, blood clots in the lungs, lungs disease, lupus, living at altitude, and others. In secondary pulmonary hypertension treatment is typically aimed at the underlying cause. For example in a patient with valve disease and pulmonary hypertension, the most important thing would be to treat the valve such as a TAVR procedure or a Mitraclip.
How Is Rvsp Measured
A right heart catheterization.
The gold standard way for obtaining the right ventricular systolic pressure and the pulmonary artery pressure is an invasive test called a heart catheterization. In a heart catheterization small tubes are passed into the heart chambers and measurements taken. Echocardiography can be used to estimate the RVSP and importantly provides a non-invasive way of doing so. Echocardiography is therefore an excellent way of identifying people with elevated RVSP and pulmonary hypertension and therefore selecting those candidates that may benefit from treatment and sometimes confirmation of the diagnosis with heart catheterization.
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There Are Four Types Of Pah
According to Galié, “most types are considered idiopathic,” meaning there’s no known cause or major precipitating factor.
About 6% of cases are heritable. They’re passed down from a parent, most likely due to a mutation in a protein receptor that affects tissue growth. “If you’re carrying this gene it does not mean you’re definitely going to develop PAH, but you are at a higher risk,” Maresta says. “We think you need more than one trigger,” such as a pre-existing condition.
The idiopathic and heritable forms of PAH are at least twice as common in women compared to men. In fact, PAH is most often diagnosed in women between the ages of 30 and 60.
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In some cases, PAH can be drug-induced. The medication most famous for causing PAH is fen-phen , a weight loss drug that was popular in the 1960s and 1970s but is no longer on the market.
Lastly, associative cases occur when PAH goes hand in hand with another pre-existing condition, such as HIV, congenital heart disease or scleroderma.
All four typesidiopathic, heritable, drug-induced and associativeare treated similarly, but the prognosis might vary as a result of which one you have.
For example, notes Maresta, patients who have associative PAH because they also have scleroderma are already more prone to renal disease, GI complications and heart complications. “That can impact your overall life expectancy,” Maresta adds.
I Had An Echocardiogram That Showed Pulmonary Hypertension What Does It Mean
Dr. T Ask Doctor T
Question:
I just learned that an echocardiogram from 2.5 years ago indicated mild pulmonary hypertension. The echo was done to try to diagnose sudden attacks of shortness of breath that have become less frequent since then. ; ;My brand new pulmonologist wants to do another echo and a CT angiogram to try diagnosing again. ;Should I be concerned that over 2 years passed with no further exploration of such a potentially deadly disease, or are we even now acting in a timely manner? ;Are there other tests that make sense as well?
Answer:
I think it is definitely worthwhile to repeat these tests especially the ECHO. I assume the CT is of your lung and its circulation.
Before I go further, my first question is about what you were told at the time, and why wasnt it repeated in 3-6 months? An ECHO is only a snapshot of what is going on at the time and needs to be viewed in context of other clinical information!
Since your shortness of breath has improved, have you noticed any decreased exercise tolerance or swelling in your legs? Most patients with PH initially experience exertional shortness of breath, lethargy, and fatigue, that may progress if the right side of the heart begins to fail.
To reassure you, and before we go further, it is unlikely that your shortness of breath would improve with PH getting worse!
PH is associated with a variety of factors:
Blood tests:
Once a diagnosis is made , treatment consists of correcting the underlying problem if possible::
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Pulmonary Hypertension Life Expectancy
Pulmonary hypertension is a chronic and progressive disease characterized by high blood pressure in the pulmonary arteries, the blood vessels of the lungs.;
There are many potential causes of the disease that, along with how early the disease is diagnosed and when treatment is started in the patient, can affect prognosis.
There is currently no known cure for pulmonary hypertension, but research is ongoing, and with the continual improvement of diagnostic techniques and therapies, it is becoming possible to diagnose the disease earlier to manage the symptoms;for longer.
Pulmonary hypertension is a progressive;disease, which means it worsens over time, although the speed varies based on the individual and the class of pulmonary hypertension. If left untreated, the prognosis is poor and the disease is often fatal within a few years, emphasizing the need for a quick and accurate diagnosis.
What Kind Of Follow
It is essential to monitor dogs with pulmonary hypertension for worsening of clinical signs. Periodic physical examinations, blood pressure monitoring, and ultrasound evaluations of the heart are also important.
Possible complications of pulmonary hypertension include heart failure, fainting, and progressive debilitation. Oftentimes, changes to the heart and lungs are irreversible, and treatment will focus on comfort care rather than curing the disease. The prognosis for pulmonary hypertension is very guarded, mostly due to the changes that can occur in the blood vessels of the lungs.
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Questions To Ask Your Physician About Your Rvsp
If your echo report says you have elevated RVSP or evidence to suggest pulmonary hypertension, the following questions may be useful to ask.
Has the study been reviewed to see if the measurements of right ventricular systolic pressure or pulmonary hypertension were accurate and not just artifact or error?
If the study is suggestive of elevated RVSP and pulmonary hypertension, what is the next step and are any other confirmatory tests required?
If the study is suggestive of elevated RVSP and pulmonary hypertension what is the likely cause and what treatment options are available?
How does the RVSP value obtained on the echocardiogram compare to that found on any previous echocardiograms?
Questions For Your Doctor
You may want to write down a list of questions before your appointment, so you can make sure you ask your doctor everything you want to. It can also help to have a friend or family member with you to help you get the answers you want.
Some possible questions are:
- What’s the best treatment for me?
- How often should I see a doctor for my condition?
- Do I need to see a specialist?
- When should I go to the emergency room?
- Do I need to limit the salt or fluids in my diet?
- What kind of exercise can I do?
- Are there any activities I should stay away from?
- Should I get a pneumonia vaccine and a flu shot?
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How Blood Flows Through Your Heart And Lungs
The lower right heart chamber, the right ventricle, receives oxygen-depleted blood and pumps it to your pulmonary arteries. The blood then travels to your lungs to be oxygenated, and on to the upper left heart chamber, the left atrium. From there, the oxygen-rich blood moves into the lower left chamber, the left ventricle, which pumps blood to the rest of your body through the aorta.
Group 4 includes pulmonary hypertension caused by blood clots in the lungs or general clotting disorders.
Is There Any Treatment For Pulmonary Hypertension In Dogs
In dogs, medications such as sildenafil , tadalafil , pimobendan , and imatinib have been used to treat this condition. Your veterinarian will guide you through the use of the drugs.
For a dog with severe breathing distress, treatment includes hospitalization with oxygen therapy and medication to dilate the breathing passages. If needed, medication to remove excess fluid from the lungs will be given. If heart failure is a component of the illness, medication to manage that disease will be added.
“Once home, it is important to maintain a low-stress environment while any underlying cardiac or respiratory disease is treated and managed.”
Once home, it is important to maintain a low-stress environment while any underlying cardiac or respiratory disease is treated and managed. Activity may need to be restricted. Avoid environments that may increase the likelihood of breathing distress, including excessively cold or dry air, excessive heat, second-hand smoke, and high altitudes. Your veterinarian will guide your nutritional choices based on any underlying disease that is present. It is important to give medications according to the directions.
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What Is Pulmonary Arterial Hypertension
Pulmonary hypertension is a life-threatening condition that gets worse over time, but treatments can help your symptoms so you can live better with the disease. It may take some planning, but plenty of people who have it find ways to do all the things they love, just as they did before they were diagnosed.
Having pulmonary arterial hypertension means that you have high blood pressure in the arteries that go from your heart to your lungs . It’s different from having regular high blood pressure.
With PAH, the tiny arteries in your lungs become narrow or blocked. It’s harder for blood to flow through them, and that raises the blood pressure in your lungs. Your heart has to work harder to pump blood through those arteries, and after a while the heart muscle gets weak. Eventually, it can lead to heart failure.
What Is Pulmonary Hypertension
Pulmonary hypertension is a rare lung disorder in which the arteries that carry blood from the heart to the lungs become narrowed, making it difficult for blood to flow through the vessels. As a result, the blood pressure in these arteries — called pulmonary arteries — rises far above normal levels. This abnormally high pressure strains the right ventricle of the heart, causing it to expand in size. Overworked and enlarged, the right ventricle gradually becomes weaker and loses its ability to pump enough blood to the lungs. This could lead to the development of right heart failure.
PH occurs in individuals of all ages, races, and ethnic backgrounds, although it is much more common in young adults and is approximately twice as common in women as in men.
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What Is Mild Pulmonary Hypertension
What is mild pulmonary hypertension? This is a disorder that affects people of all ages. It is characterized by decreased pressure in the lungs. The usual cause for this is having high blood pressure. It can also be caused by the buildup of fatty deposits around the heart. The symptoms of mild pulmonary hypertension include shortness of breath during major physical exertion, coughing with or without mucus, wheezing and breathlessness.
The treatment of mild pulmonary hypertension includes drugs, such as diuretics orophylline, or surgical procedures. However, you may be wondering if the medication is really the best treatment option. You have to remember that this type of illness often occurs due to previous health conditions. Therefore, taking medication only cover up the symptoms and will not cure the illness itself.
Another question that you might be asking yourself is, Is there anything else that could help treat this disease? One way of treating mild pulmonary hypertension is by dealing with the underlying cause of it. For example, some patients who have a cough that causes difficulty in breathing have been known to be treated with medicine. But the treatment is only temporary and will only bring about relief from the short-term effects of the cough. In the long run, the patient would still have problems breathing.
What Are All The Signs Of Pulmonary Hypertension In Dogs
Most of the signs of pulmonary hypertension are due to high blood pressure in the pulmonary arteries. These signs include:
- exercise intolerance
- difficulty breathing with or without exertion/exercise
- rapid breathing
- spitting up blood from the lungs
- fainting
- weight loss
- heart murmur
- bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood
- distended jugular veins in the neck
- fluid buildup under the skin
- sudden death
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Ph Associated With Chronic Thromboembolic/embolic Disease
A thrombus or thromboembolism is a blood clot that blocks the passage of blood through a vessel. If blood clots travel to the lung, the obstruction may lead to pulmonary hypertension. Sometimes blood clots in the lungs do not cause symptoms. Pulmonary Hypertension caused by blood clots is rare and may require surgical removal of the clots by a procedure called thromboendarterectomy.
There are many diseases that can cause pulmonary hypertension . The following is a brief explanation of each of these conditions.
What Causes Pulmonary Hypertension
The following are some known causes of pulmonary hypertension:
- The diet drug “fen-phen.” Although the appetite suppressant “fen-phen” has been taken off the market, former fen-phen users have a 23-fold increase risk of developing pulmonary hypertension, possibly years later.
- Liver diseases, rheumatic disorders, lung conditions. Pulmonary hypertension also can occur as a result of other medical conditions, such as chronic liver disease and liver cirrhosis; rheumatic disorders such as scleroderma or systemic lupus erythematosus ; and lung conditions, including tumors, emphysema, chronic obstructive pulmonary disease , and pulmonary fibrosis.
- Certain heart diseases. Heart diseases, including aortic valve disease, left heart failure, mitral valve disease, and congenital heart disease, can also cause pulmonary hypertension.
- Thromboembolic disease. A blood clot in a large pulmonary artery can result in the development of pulmonary hypertension.
- Low-oxygen conditions. High altitude living, obesity, and sleep apnea can also lead to the development of pulmonary hypertension.
- Genetics. Pulmonary hypertension is inherited in a small number of cases. Knowing that someone in the family had or has pulmonary hypertension should prompt you to seek early evaluation should symptoms occur.
Pulmonary hypertension may also be caused by other conditions, and in some cases, the cause is unknown.
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When To See A Gp
See a GP if you have any symptoms of pulmonary hypertension. They may ask you about your symptoms and medical history, and they may carry out a physical examination.
Correctly diagnosing pulmonary hypertension can sometimes take time because its;symptoms are similar to those of many other heart and lung conditions.
Tests;you may have;include a type of heart scan called an echocardiogram, and right heart catheterisation, where a thin, flexible tube is inserted into your pulmonary artery.
The changes in the pulmonary arteries that lead to pulmonary hypertension can be caused by:
- problems with the smaller branches of the pulmonary arteries
- conditions that affect the left side of the heart
- lung diseases or;a shortage of oxygen in the body
- blood clots;that cause narrowing or a blockage in the pulmonary arteries
Read more about the;causes of;pulmonary hypertension.
Pulmonary Hypertension Definition And Facts
- Pulmonary hypertension is abnormally elevated pressure in the pulmonary circulation.
- The classification of primary and secondary pulmonary hypertension has been reclassified, and now is based on the main underlying disease or condition, symptoms, and treatment options for pulmonary hypertension. There are five classes or groups in this new classification system.
- Pulmonary hypertension can have no identifiable cause and is then referred to as idiopathic pulmonary hypertension .
Pulmonary hypertension occurs when the pressure in the pulmonary arteries increases abnormally. To help explain this condition further, here is how the pulmonary arteries work.
What are pulmonary arteries?
The human body has two major sets of blood vessels that distribute blood from the heart to the body. One set pumps blood from the right heart to the lungs, and the other from the left heart to the rest of the body . When a doctor or a nurse measures the blood pressure on a person’s arm, he/she is measuring the pressures in the systemic circulation. When these pressures are abnormally high, the person is diagnosed as having high blood pressure .
The portion of the circulation that distributes the blood from the right side of the heart to the lungs and back to the left side of the heart is referred to as the pulmonary circulation.
What are normal pulmonary artery pressure ranges?
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Other Medications And Treatments
Other medications used to treat PH include digoxin , which helps the heart pump stronger. Digoxin is also used in some to treat heart failure or other heart disease.
Excess fluid can build up in the feet and ankles of people with PH. Diuretics are prescribed to help bring fluid levels back to normal. Oxygen therapy may also be required to help increase oxygen levels in the blood.
Exercise and a healthy lifestyle are also essential to long-term PH treatment, which can be tailored to ones specific needs with your doctors guidance.