Pulmonary Hypertension: Misdiagnosis and Next Steps

Q: Pulmonary Hypertension: Misdiagnosis and Next Steps

Hello： Pulmonary hypertension refers to elevated blood pressure in the pulmonary arteries, which can damage the blood vessels in the lungs and potentially lead to increased cardiac workload, resulting in heart disease. <br>Echocardiography can estimate pulmonary artery pressure,

Regarding pulmonary artery diagnostic issues?

Hello, doctor.
Over a decade ago, I experienced shortness of breath while walking and consulted a cardiologist.
During an echocardiogram, the doctor mentioned that I had pulmonary hypertension, but did not provide any specific diagnostic numbers or recommend further tests.
Later, blood tests revealed severe iron deficiency anemia, which was treated and returned to normal, alleviating my shortness of breath while walking.
At that time, I was unaware of what pulmonary hypertension was, and the doctor did not suggest any additional examinations.

Years later, I sought treatment for panic attacks and heart palpitations, undergoing multiple normal electrocardiograms.
Two echocardiograms showed that my heart was enlarged, attributed to hypertension, for which I am on medication.
The other echocardiogram indicated very mild relaxation of the heart valves.
Different doctors I consulted did not mention the issue of pulmonary hypertension.
Over the years, I have not experienced shortness of breath, coughing, ankle swelling, or dizziness.
Could the diagnosis of pulmonary hypertension from over a decade ago have been incorrect, or could there be other reasons? If I do not exhibit typical symptoms of pulmonary hypertension, do I still need to undergo further testing? Thank you.

Mi Mi, 50~59 year old female. Ask Date: 2023/05/14

Dr. Huang Yinghe reply Cardiology

Hello: Pulmonary hypertension refers to elevated blood pressure in the pulmonary arteries, which can damage the blood vessels in the lungs and potentially lead to increased cardiac workload, resulting in heart disease.
Echocardiography can estimate pulmonary artery pressure, but it can be influenced by various factors, leading to inaccuracies.
For example, lung diseases such as emphysema and pneumonia may cause elevated pulmonary artery pressure, and different body positions, heart rhythms, and the condition of the pulmonary valve during the ultrasound can also affect the measurements.
To establish a diagnosis and assess severity, direct measurement of pulmonary artery pressure via cardiac catheterization is necessary.
Generally, if there are related symptoms and echocardiography suggests pulmonary hypertension, further evaluation or referral to a specialist in pulmonary hypertension should be considered.
It is advisable to consult your physician for more detailed information.

Reply Date: 2023/05/14

More Info

Pulmonary hypertension (PH) is a complex condition characterized by elevated blood pressure in the pulmonary arteries, which can lead to significant cardiovascular complications. Your situation raises several important points regarding the diagnosis, management, and potential misdiagnosis of pulmonary hypertension.

Firstly, it is crucial to understand that pulmonary hypertension can be secondary to various underlying conditions, including heart disease, lung disease, and even systemic conditions like anemia. In your case, the initial diagnosis of pulmonary hypertension was made over a decade ago, coinciding with your severe iron deficiency anemia. Anemia can lead to symptoms such as shortness of breath, which may have been misattributed to pulmonary hypertension at that time. After treating your anemia, if your symptoms improved significantly, it raises the possibility that the initial diagnosis was either incorrect or that the pulmonary hypertension was transient and related to your anemia.

The absence of typical symptoms of pulmonary hypertension—such as exertional dyspnea (shortness of breath with activity), fatigue, chest pain, and edema (swelling)—is also noteworthy. Patients with significant pulmonary hypertension often present with these symptoms, especially during physical exertion. Since you have not experienced these symptoms for many years, it is reasonable to question the accuracy of the initial diagnosis.

Regarding the need for further evaluation, it is advisable to consider a few factors. If you are currently asymptomatic and have no signs of pulmonary hypertension (such as swelling in the ankles, dizziness, or significant exertional dyspnea), the urgency for further testing may be lower. However, given your history of heart issues and hypertension, it might be prudent to have a follow-up evaluation. This could include a repeat echocardiogram to assess your heart's structure and function, as well as to estimate pulmonary artery pressures. If there are any concerns or if symptoms develop, more definitive tests such as right heart catheterization may be warranted.

In terms of management, if pulmonary hypertension were to be confirmed, treatment options would depend on the underlying cause. For instance, if it were secondary to heart disease, managing the heart condition could alleviate the pulmonary hypertension. Lifestyle modifications, such as maintaining a healthy weight, regular exercise, and adhering to prescribed medications for hypertension, are also essential.

Lastly, it is important to maintain open communication with your healthcare providers. If you have concerns about your previous diagnosis or current symptoms, discussing these with a cardiologist or a specialist in pulmonary medicine can provide clarity and guide you on the next steps. They can help determine whether further testing is necessary based on your current health status and history.

In summary, while the initial diagnosis of pulmonary hypertension may have been accurate at the time, your subsequent improvement and the absence of symptoms suggest that it may not be a current concern. However, given your medical history, a follow-up evaluation could provide peace of mind and ensure that any potential issues are addressed promptly.

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