Heart & Cardiology/PA pressure on echo


QUESTION: I have had 3 echos in the past 3 years. My PA pressure the first time was 34, second time 39 and last time was 46 mmHg. I had a right and left heart cath done on 9/20 which showed a PA pressure of 27mmHg, checked 3 times by the cardiologist. The P2 is loud on A and P. What would account for the elevating PA pressures on echo and yet it is normal by right heart cath. I have SLE and I do have some valve thickening, normal EF, no stenosis. On lung CT, I have pleural thickening and interstitial changes. I quit smoking 29 years ago and was a 1/2 pack per day for 10 years prior. I know lupus is causing some of the changes I have due to connective tissue disease but it just seems to strange to  me, thankfully so, that I do not have PH with all of the other findings. Thanks for your response.

ANSWER: Hi Carol,
You have pulmonary hypertension. In some people the cause is not known.
Read more here:
Hope this helps,
Dr T

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

QUESTION: Thank you Dr. T. What confuses me is that my cardiologist said I don't have PH based on the right heart findings, yet I have moderate tricuspid regurg and other valve thickening. I don't have any real SOB but it does take a while for me to recover from strenuous exercise. I did the 6 minute walk test w/o any problems. I don't want to make my dr feel like I don't trust him but he rechecked the pressure 3 times during heart cath. I also wrote to the lupus.org foundation to see if Plaquenil could affect the PAP. I have been off of it for 4 months and the PAP was 20 mmHg lower on right heart cath. Any suggestions? Would you see a specialist in PH in this scenario? I'm sorry to bother you. I just feel sort of unsettled about this whole issue.

Hi Carol,
You have some legitimate questions that I cannot answer fro you, since I am a cardiac surgeon and my expertise lies in the surgical options for treatment (not applicable in your situation). Best to go forward with your cardiologist and/or a second opinion.
Hope this helps,
Dr T

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