Mild Pulmonary Hypertension: Should I Be Concerned?

Waking up always accompanied by palpitations—could I have pulmonary hypertension?

Due to tinnitus and insomnia, I have no family history of illness.
During examinations, it was discovered that my thyroid levels were 0.2 above the normal range.
I visited the endocrinology department at Hospital A, where my thyroid medication was reduced.
Blood tests returned normal results.
The physician also conducted a cardiac examination and determined that I could discontinue Entresto.
Currently, I am only taking one antihypertensive pill daily.
A few days later, I obtained my health report, which showed the following results:
1.
Normal size of the four cardiac chambers
2.
Preserved left ventricular (LV) systolic function with an LVEF of 60.5%
3.
No regional wall motion abnormalities
4.
Preserved LV diastolic function
5.
No intracardiac shunt, thrombus, or pericardial effusion
6.
Billowing of the anterior mitral leaflet (AML) into the left atrium (LA) during systolic phase, consistent with mitral valve prolapse (MVP)
7.
Color Doppler findings: mild tricuspid regurgitation (TR), mild mitral regurgitation (MR)
8.
Mild pulmonary hypertension with estimated systolic pulmonary artery pressure (sPAP) of 32 mmHg
9.
ECG: sinus rhythm
After reviewing the eighth item, I immediately consulted the internal medicine department at National Taiwan University Hospital, which advised me to return to my original hospital for further examinations for convenience.
Upon returning to my original hospital, I consulted an unfamiliar cardiologist, who refused to conduct further tests and dismissed me as an anxiety disorder patient.

Regarding my first question, I learned that the mild TR and mild MR could explain my palpitations.
Can I recover or improve through exercise? Is there anything I need to pay attention to?
For my second question, I do not consider myself an anxiety disorder patient; I have undergone psychological counseling and confirmed that I am not an anxiety disorder patient, just someone who tends to get nervous easily.
The sleep clinic at National Taiwan University did not prescribe any medication for me.
Initially, I relied on 0.5 mg of Rifampicin (two pills) to sleep through the night, but I have since stopped the medication and am gradually getting used to the tinnitus.
Now, I experience light sleep and often wake up but can fall back asleep on my own.
My palpitations only occur when I get up or wake up at night.
The cardiology department at Hospital A prescribed me 0.5 mg of Amiodarone and Entresto to be taken three times a day.
Should I take them?
The most important third question is regarding the mild pulmonary hypertension I found alarming.
It states that I have mild pulmonary hypertension, and I checked that the normal value is 25, while mine is 32.
It is said that untreated, it could lead to death in three years.
Initially, I have no obvious symptoms, and aside from becoming more easily fatigued, I seem fine.
Should I be concerned and seek further examination, or am I just neurotic and anxious as the physician at Hospital A suggested? Could the significant stress from my tinnitus cause the eighth item to exceed the normal range? The physician at Hospital A mentioned that a deviation of seven is normal and that I really do not need to seek medical attention.

A, 20~29 year old female. Ask Date: 2020/04/17

Dr. Wu Xueming reply Cardiology

1.
Mild tricuspid regurgitation (TR) and mild mitral regurgitation (MR) do not affect cardiac function and do not cause symptoms.

2.
Palpitations are mostly benign.
Factors such as stress, tea, alcohol, smoking, coffee, hyperthyroidism, or stimulation of the sympathetic or vagus nerves can cause irregular heartbeats.
If reducing stress and alcohol consumption does not improve the situation, pharmacological treatment may be considered.

3.
The measurements of pulmonary vascular pressure obtained via ultrasound can be influenced by various factors, leading to discrepancies with actual values; therefore, mild pulmonary hypertension should not be a cause for concern.

Reply Date: 2020/04/17

More Info

Mild pulmonary hypertension (PH) can indeed be a source of concern, especially when you first learn about it. However, understanding the condition and its implications is crucial for managing your health effectively. Let’s break down your concerns and provide some clarity.

Understanding Mild Pulmonary Hypertension
1. What is Mild Pulmonary Hypertension?
Mild pulmonary hypertension is defined as an estimated pulmonary artery pressure (sPAP) of 25-35 mmHg. In your case, with a reading of 32 mmHg, you fall into this category. While it is above the normal range (which is typically considered to be less than 25 mmHg), it is still classified as mild.
2. Should You Be Concerned?
While any elevation in pulmonary artery pressure warrants attention, mild pulmonary hypertension does not necessarily mean you are facing a dire health crisis. Many individuals with mild PH can lead normal lives without significant symptoms or complications. The key is to monitor the condition and manage any contributing factors, such as weight, physical activity, and overall cardiovascular health.

3. Symptoms and Management:
You mentioned experiencing heart palpitations and fatigue. These symptoms can be related to various factors, including anxiety, stress, and possibly the mild pulmonary hypertension itself. It’s essential to differentiate between symptoms caused by PH and those stemming from anxiety or other conditions. Regular follow-ups with a healthcare provider can help in this regard.

Lifestyle Modifications
1. Exercise and Physical Activity:
Regular exercise can be beneficial for cardiovascular health and may help improve your overall condition. However, it’s essential to consult with your healthcare provider before starting any new exercise regimen, especially with your current health concerns. They can guide you on the appropriate level of activity based on your specific situation.

2. Diet and Weight Management:
Maintaining a healthy weight can significantly impact your cardiovascular health. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins, combined with regular physical activity, can help manage your weight and improve your overall health.

3. Stress Management:
Since you mentioned feeling more anxious and stressed, incorporating stress-reducing techniques such as mindfulness, meditation, or yoga can be beneficial. These practices can help manage anxiety and may also positively affect your heart health.

Medication Considerations
1. Current Medications:
Regarding the medications prescribed to you, it’s crucial to follow your healthcare provider’s advice. If you have concerns about taking certain medications, such as the anti-anxiety medication, discuss these with your doctor. They can help determine whether these medications are appropriate for your situation.

2. Monitoring and Follow-Up:
Regular follow-ups with your healthcare provider are essential. They may recommend periodic echocardiograms or other tests to monitor your pulmonary artery pressure and overall heart function. If your symptoms worsen or if you develop new symptoms, it’s important to seek medical advice promptly.

Conclusion
In summary, while mild pulmonary hypertension should be taken seriously, it does not automatically indicate a life-threatening condition. With appropriate lifestyle modifications, regular monitoring, and open communication with your healthcare provider, you can manage your health effectively. If you continue to experience significant anxiety or if your symptoms change, consider seeking a second opinion or consulting a specialist in pulmonary hypertension for further evaluation and guidance. Remember, knowledge and proactive management are your best tools in navigating this condition.

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