Wednesday, September 3, 2014
Is this mild PH?
I had a large PE and a lung infarct as a result of the PE. An echocardiogram shows the following results:
- RVSP of 33mmHg
- Mild mitral regurgitation, mild pulmonic regurgitation, and trace tricuspid regurgitation
- No evidence of aortic regurgitation, and aortic valve structure is normal
- No pericardial effusion
- Right atrium, ventricular chamber sizes, systolic functions normal
- Left ventricular atrium and chamber size is normal. Left ventricle chamber size, wall thickness and systolic function are within normal limits. No motion abnormalities observed. Ejection fraction normal.
- EF is approximately 60%
My questions are:
- Is this considered mild PH?
- If not, is this something to watch and get possible follow-up echocardiograms on?
- If not, does having the lung infarct predispose me to getting PH later on? (Is this something I have to watch out for because of the infarct?)
- Does the RVSP ever go down on its own as more recovery from the PE and infarct goes on?
- Is there anything about the mitral, pulmonic and tricuspid regurgitation results that are a potential cause for concern either now or down the line because of the lung infarct?
Thank you for your questions.
The elevated estimated RVSP reading from the echocardiogram suggests that your pulmonary embolism has caused some pulmonary hypertension. An echocardiogram provides only an estimation, however, and only a right heart catheterization provides a definitive measurement.
At this time, you do not need a right heart catheterization. The majority of patients with pulmonary emboli will have complete or near complete resolution of their clot. A minority of patients will have incomplete resolution of the clot as well as some other vascular changes, which lead to the development of chronic thromboembolic pulmonary hypertension. We cannot always identify which patients will develop this problem, although patients with large pulmonary emboli appear to be at increased risk.
I feel that patients with large or multiple pulmonary emboli and changes on echocardiogram should be followed at least with periodic echocardiograms. If the changes on echocardiogram do not resolve, further evaluation by a pulmonary hypertension specialist is warranted.
Pulmonary infarction due to pulmonary embolism has not been demonstrated to be a definite risk factor for the development of pulmonary hypertension.
The majority of patients will resolve their clots and, in turn, the echocardiographic findings will normalize as well. However, those that do not, require further observation over time.
The tricuspid regurgitation reflects the elevated pressure in the right ventricle as fluid is leaking backward through this valve. The velocity of regurgitant blood flow is used to estimate the RVSP. The pulmonic regurgitation may be related to the pulmonary embolism or it may be a minor incidental finding. These will typically improve with resolution of the clot. The mitral regurgitation is not related to the pulmonary embolism. Your treating physicians will make a decision if further evaluation of this is necessary.
Douglas W Haden, MD
College of Medicine
The Ohio State University