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Thursday, July 31, 2014
Do I need another RHC?
I am a 45 year old female with an 18 month history of increasing SOB, chest pressure, dizziness and declining endurance. In the past year I have had PFT`s, ECG`s, lung scan, cardiac CT and 6 echoes. All of the echoes have shown a pressure of 44 to 46. All other tests have been normal. RV last measured 31mm. Last May I had an RHC which showed my pressure as 28/10, normal. It was not done with exercise. Since my doctor has found no other abnormality, is it reasonable to repeat the RHC but do it with exercise even though a year later my RV is still normal in size?
Thank you for your question. You have presented a challenging situation with no clear correct answer. Based on your description, it appears that you are significantly disabled by your symptoms including shortness of breath. It is possible that you are developing pulmonary hypertension during exercise, although the clinical significance of this remains uncharted territory. It would be unusual for pulmonary hypertension to cause symptoms as severe as you describe and to have entirely normal resting pulmonary pressures.
A RHC performed during exercise is a reasonable test to perform in this situation, although the results must be carefully interpreted. A formal cardiopulmonary exercise test might be of some benefit as well as you appear to have unexplained shortness of breath, and this test is commonly used to help sort this out.
Douglas W Haden, MD
College of Medicine
The Ohio State University