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Medical Forum / General / Cardiology / March 2007Another question about right heart catherizations and pulmonary stenossi/PH
ok, so my doctor wants me to get one to see if i have pulmonary hypertension, and if i still have a congenital pulmoary artery stenosis, that we fear i may not have outgrown. all i gotta do is call them back, and say i'll do it. and they will schedule it. the doctor wrote out the test request form already. ive had a regular echo and stress echo done and nothing can view this area properly, though the one echo claims that via continuous doppler, etc.. that there is no evidence of pulmonary hypertension and my chest x-ray (regular.. NOT a CT scan), didnt show any enlarged area of my heart in that regard or anything severe enough to show up on that. would it though? anyways, on my recent EKG's and symptoms, as you all might know, have shown right heart strain pattern.. RBBB, and borderline/possible right atrial enlargement.. and along with my symptoms.. of shortness of breath, tachycardias, etc.. they think somethings mainly up with the Pulmonary thing. ok, my questions are: will a right heart cath be able to rule our right atrial/ventricular failure? will it be able to measure or get an idea, a better idea if its enlarged or failing yet? would it be able to see if i have the pulmonary stenosis still? the doctor claims this will just measure the pulmonary pressures.. what abut the right ventricular EF, etc and pressures? will this cath be able to VIEW.. the actual pulmonary artery and see it, like a regular cath to see if theres coronary disease? my mom got to take pics home of hers from the hospital. is it true that no matter what.. no matter how mild or severe the pulmonary artery stenosis is, that you will have some degree of pulmonary hypertension? this is what my doctor says. he says if it shows a PH, then that means the stenosis is probably still there. yeah but what about seeing the narrowing? will it be able to view the artery? is this the best route? really? i know they can do a transesophogeal echocardiogram, but even that supposedly can still be a bit vague. he said i can do either right now. whats your opinion? > ok, so my doctor wants me to get one to see if i have pulmonary > hypertension, and if i still have a congenital pulmoary artery [quoted text clipped - 8 lines] > heart in that regard or anything severe enough to show up on that. > would it though? Not necessarily for something like recurrent subacute PEs. > anyways, on my recent EKG's and symptoms, as you all might know, have > shown right heart strain pattern.. RBBB, and borderline/possible right [quoted text clipped - 7 lines] > failure? will it be able to measure or get an idea, a better idea if > its enlarged or failing yet? The purpose of the right heart cath is to measure pressures and to sample venous blood to possibly detect congenital heart disease. > would it be able to see if i have the pulmonary stenosis still? It would be able to detect it by measuring a pressure gradient across the valve. > the doctor claims this will just measure the pulmonary pressures.. > what abut the right ventricular EF, etc and pressures? Not EF but pressures. " will this cath > be able to VIEW.. the actual pulmonary artery and see it, like a > regular cath to see if theres coronary disease? The coronaries come off the aorta and not the PA. > my mom got to take pics home of hers from the hospital. Yours won't be like your mom's left heart cath with coronary angiography. > is it true that no matter what.. no matter how mild or severe the > pulmonary artery stenosis is, that you will have some degree of > pulmonary hypertension? this is what my doctor says. It is likely a misunderstanding on your part and a miscommunication of your doctor's part. > he says if it shows a PH, then that means the stenosis is probably > still there. yeah but what about seeing the narrowing? will it be able > to view the artery? The stenosis occurs at the level of the pulmonic valve so that if there is pulmonary hypertension it will be in addition to pulmonary stenosis and not be because of it. > is this the best route? really? i know they can do a transesophogeal > echocardiogram, but even that supposedly can still be a bit vague. > > he said i can do either right now. whats your opinion? The right heart cath should be more definitive than a transesophageal echocardiogram. Andrew B. Chung, MD/PhD http://EmoryCardiology.com > > ive had a regular echo and stress echo done and nothing can view this > > area properly, though the one echo claims that via continuous doppler, [quoted text clipped - 4 lines] > > Not necessarily for something like recurrent subacute PEs. i meant, woud it show enlarged pulmonary arteries or something? > > is it true that no matter what.. no matter how mild or severe the > > pulmonary artery stenosis is, that you will have some degree of > > pulmonary hypertension? this is what my doctor says. > > It is likely a misunderstanding on your part and a miscommunication of > your doctor's part. nope, he and i have discussed this several times and he made this very clear. "no matter what, you had PS as a child, so no matter what, you had some degree of PH. even if you outgrew it, it could still remain. but unlikely." > > he says if it shows a PH, then that means the stenosis is probably > > still there. yeah but what about seeing the narrowing? will it be able [quoted text clipped - 3 lines] > there is pulmonary hypertension it will be in addition to pulmonary > stenosis and not be because of it. wait, wouldnt the PH be cause because of the obstructuve blood flow cause BY the PS? why would it exist separately? you mean as a separate, entitity, per se? > > is this the best route? really? i know they can do a transesophogeal > > echocardiogram, but even that supposedly can still be a bit vague. [quoted text clipped - 3 lines] > The right heart cath should be more definitive than a transesophageal > echocardiogram. but, in the cath, all theyre gonna see is the Pulmonary pressure.. and nothing else. say they find a high PH... how else are they gonna determine why? largest theory would be that this PS still is there. so, they have to find a reason behind it.. and it could be something that could be corrected.. if it is the PS. so how else will they find out if theres a PS there? if an echo doesnt work. they stick mini camera things and other transducers and other readers into the body and they cant view my pulomary arteries like they did my moms coronary cath, for example? i dont get it. so the kind she had can visualize stuff, but the right heart cath wont? is there anything that will? this makes no sense to me. how are so many other people getting diagnosed with PS and i was once diagnosed with PS as a child, but they cant determine anything now? determining if it the PS still there could be a matetr of saving my life in the future or not. my doc also suggested me going to Univerisity of Pennsylvania, and seeing their cardio/pulm specialists instead. think i should ust go this route? > > > ive had a regular echo and stress echo done and nothing can view this > > > area properly, though the one echo claims that via continuous doppler, [quoted text clipped - 16 lines] > nope, he and i have discussed this several times and he made this very > clear. If this is true that your doctor (cardiologist?) has told you that pulmonary stenosis causes pulmonary hypertension, you would be wise to change doctors. Perhaps your doctor is already indicating this with his/her recommendation that you seek care at a tertiary university hospital. Andrew B. Chung, MD/PhD http://EmoryCardiology.com |
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