Heart & Cardiology/Echo results

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Hi..I had echo done at end of Oct this year. The first one I have ever had. The results are...moderate mitral regurgitation, mild tricuspid regurgitation, and mild pulmonary hypertension... RSVP 37. ALL valves, normal in function, mobility,and IVC is normal with preserved collapse...normal right atrium pressures. Normal left diastolic, and sytolic pressures...no stenosis of valves, and EF 55%-60%. Left and right ventricular valves normal in structure.
What would the mildly elevated PH be from? The mitral regurgitation? My cardiologist having me back in 3 months, he put me on no meds, nothing. I asked if I should see specialist, and nurses reply, ITS SO MILD. Is his coarse of action in treatment correct? Watching? I have no symptoms, and can walk miles, no S.O.B. nothing. Is it possible echo overestimated? I mentioned RHC...but no in cards yet. I have been scared and anxious. If it is valve regurgitation, will repair correct the PH??

Answer
Hi, http://blog.myheart.net/2014/06/01/leaky-heart-valve-when-the-mitral-valve-fails

I'm not clear on why you had the test, the findings can be interpreted differently in the setting of symptoms, or no symptoms. The PA pressure is calculated by using the derived velocity of the tricuspid regurgitation and this is then added to the right atrial pressure, derived from the IVC to obtain an estimate. Importantly this is an estimate. There can be errors in the measurement of the tricuspid jet and also the IVC and therefore multiple sources of error in arriving at a final value. The person reading the echo officially usually reviews these components, but often there can be oversights. Even when accurately measured, an elevated PA pressure estimated form echo can still often be normal when more invasive studies such as cath are done.

Reassuringly pretty much all the components of your echo are normal otherwise, and importantly you seem to have no symptoms. Its reasonable to ask the simple question from your cardiologist, "Do I have pulmonary hypertension" (looks relatively mild even if you did). To answer that your echo will be reviewed and the components assessed for quality. Finally however, even if you did have mild pulmonary hypertension, you wouldn't be doing much more than lifestyle changes and continuation of watching your cardiac risk factors. I doubt you have anything serious at all going on, otherwise, they would have likely told you already. I'm not able to comment in detail as I haven't seen or taken a history from you. As for the valve regurgitation, moderate mitral regurgitation is highly unlikely to be associated with the elevation in PA pressure and if your chamber sizes are normal there appears to be no reason to suspect the regurgitation is more severe. I certainly wouldn't recommend fixing a moderately leaky valve in this setting. In the case of a mildly elevated estimated PA pressure in an asymptomatic patient with an otherwise relatively normal echo there is typically no indication to do a RHC.

Hope that was helpful,  

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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