Heart & Cardiology/PH


Hi: I am 38 yo Caucasian male, 69 in, 173.5 lb. I have hypertension (~140/70), which so far is not affected by medication (I take different medications since 2007, currently I am on ACE inhibitors). I have very active lifestyle, do a lot of outdoor activities, bike every day, kayak and other activities. I feel in a good health, but since recently I start collecting mucose in my throat when exercise. One year ago I had frequent episodes of being out of breath during sleep after weight lifting. When I had these episodes, I had to move to sleep in a more vertical position and it solved the problem. But since I stop going to the gym and corrected my eating habits, this problem disappeared. But I have shortness of breath after eating (I eat fast), but only when my stomach is full. I visited a physician after I started collectin mucose in my throat. The physician sent me to a Pulmonary Function Test and the results shown that "forced expiration demonstrates mild obstructive ventilatory defect without an immediate response to bronchodilators. Spirograms plateau normally. Flow volume loops show decreased flow at low lung volumes, indicated increased pulmonary capillary blood volume. Diagnosis: Mild obstructive ventilatory defect.". My ECGs in 2007 and 2014 shown signs for LVH, but non of the ECGs in the period between 2007 and 2014. I was sent to echocardiogram and it shown "normal left ventricular systolic function. EF estimated at 65-75%. Normal diastolic function. Top normal right ventricular size. Normal right ventricular global systolic function. RVSP estimated at 35-40% mmHg. Top normal RVSP." Also, trace mitral and tricuspid regurgitation noted.

I am quite concerned about my situation, especially about the RVSP. I don't understand why 35-40% mmHg is considered as normal.

I would appreciate very much your answer. Thank you very much in advance!

Hi, there are several articles regarding heart tests at http://blog.myheart.net.

It sounds like you have had quite a work up for your symptoms. So far fairly normal PFT's, normal systolic and diastolic function on echo with RVSP of 35-40. You used to get short of breath when you slept after exercising and change of sleep position helped that in addition to changing eating habits and stopping gym. And now your major symptom is collecting mucous in your throat when you exercise.vYour symptoms are atypical and fairly non specific (i.e. not classic for any one underlying disorder) and that makes any work up difficult and so the general approach is to rule out serious things first. The good thing is that none of your tests appear to show anything markedly abnormal so far.

From a heart point of view just a few things. The fact you are still able to do a lot of outdoor activities and have an active lifestyle make a significant underlying problem unlikely, and it makes your prognosis good. Your echo RVSP estimate that we use to estimate the pulmonary pressure is at the higher end of normal, however its important to note that the use of pressure estimation by echocardiography may often be inaccurate and lead to overestimation of the pressure, this is for several technical reasons. I wouldn't worry too much if i were you if nothing was specifically highlighted by the reading physician. If there is concern that the pressures are high then a test called a right heart catheterization test may be used to confirm this in symptomatic patients. Although if your symptoms of breathlessness are not present then most people would generally not pursue this. One other avenue to pursue if your symptoms of breathlessness came back is exercise testing (exercise stress and exercise right heart cath are examples). Its important to note that tests done at rest do not necessarily reflect the exercise state.

Finally the mucous in your throat is highly unlikely to be related to a cardiac cause. Symptoms of breathlessness are often multifactorial and may involve the heart, the lung, both or none and when no cause is found it can often be frustrating. In your case the symptoms described and the findings so far are not concerning for anything serious. But if you remain limited then it is reasonable to seek an opinion from heart and lung specialists.

Hope that was helpful,  

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Mustafa Ahmed MD


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


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


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

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

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