Heart & Cardiology/mild PH

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QUESTION: I'm a 53y/o female with a very complicated history (HTN,COPD,OSA,SIADH,Carnitine deficiency hypermobility disorder,and IFG).
My echo results came back with the following findings: left atrium mildly dilated, small pericardial effusion, borderline pulmonary hypertension.

IVSd- 1.2cm
LVPWd- 1.1cm
FS- 51%
LA- 4.7cm
EDV- 71ml
ESV- 26ml
EF- 63%
SV-45ml
MV max V 446cm/sec
MV max PG 80mmHg
TR max V 271cm/sec
TRmax PG 29mmHg
RSVP- 39mmHg
RAP- 10mmHg

I'm quite concerned with the results.  I questioned my PCP and the only response was that I had to make sure that I was vigillant in treating my OSA.  I've been experiencing severe edema in both legs which extends to the abdomen despite wearing compression hose for the past 3 years.  In the past few months, prior to the echo, I've been experiencing SOB climbing one flight of stairs in my house.

Should I be concerned enough to have this evaluated further and if so by whom?

Thank you,
Diane

ANSWER: Hello Diane,

Congestive heart failure causes SOB and edema, but usually makes one breathless lying down.  One can have CHf despite a normal EF.  In that kind of heart failure, called diastolic heart failure, the heart can contract well enough (EF 63)  but doesn't relax well, so the pressures in the heart rise because the heart can't relax well, and that raises the pressure of blood in the lungs and legs and causes SOB and edema.  Small pericardial effusion is normal, and the pulmonary hypertension can be the result of left heart diastolic failure and is unimportant.  Left atrial dilation can come from failure of the left ventricle to relax well.  

Can SIADH cause edema?   COPD could certainly cause SOB on climbing stairs.

Please find out if SIADH causes edema.  I suggest seeing a cardiologist.

Please write back if you think I could help more.

David Richardson

---------- FOLLOW-UP ----------

QUESTION: Thank you for quick response, I truly appreciate you assistance.

Let me clairify a few things.  The SIADH only causes edema for about 12-24 hours prior to diuresis.  I'm on 1000cc fluid restriction to treat it and my sodium has remained within normal limits.  The SIADH started in 2005 and no cause has been determined.  I was also diagnosed the same year with moderate COPD and quit smoking that year.  The COPD has been asymptomatic for the past 6 years and I'm not on any medications for it.  I'm currently on a low dose of Lasix(20mg) and Potassium for the edema, which is somewhat helpful. The SOB started about 6 months ago and has been increasing. Pulse ox readings average between 93-95%.  Also the head of our bed is elevated (on cinder blocks) to due my husband's silent aspiration.  I do use my C-PAP nightly, but frequently remove my mask in my sleep, so treatment isn't optimal.

The echo report states that a variety of doppler measurements indicate normal left ventricular diastolic function. It is also negative for regurgitation for any valves.  No hemodynamically significiant aortic stenosis.  Normal LV systolic function, RV is grossly normal size, MV is grossly normal, no MV stenosis.  The changes are new since the last study in 2009.

I don't know if any of this information will be helpful to you.  I will follow up with your advice and see a cardiologist.

Again, thank you.
Diane

Answer
Those findings seem to eliminate diastolic heart failure.  Try a little more Lasix for a few days to see if that impr0ves your breathlessness.  A cardiologist may be able to figure out what's causing it.  Please let me know when you find out what's the best management.

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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