What Do My Lab Test Results Indicate?

Posted on Wed, 10 Aug 2016

Question: Echo report states trace mitral regurgitation and trace to mild tricuspid regurgitation. I also have PACs. I am 39, 5'8" and 180 pounds, and had a submassive PE a year ago while pregnant. V/Q scan came back as low probability and recent chest CT scan came back clear. Echo shows a normal PASP, although it has increased by 7 points since January of this year. Is it normal for PASP to vary within a normal range? Should I be concerned about regurgitation and PACs given my history of PE?

Answered by Dr. Saddiq Ulabidin (1 hour later)

Brief Answer:
Need CT PA and D dimers to exclude pumonary embolism at this stage

Detailed Answer:
Hi! Welcome to health care magic!
Thanks for sharing your concerns with us. We will try to help you in best way possible.

First of all, it is sad to know what you had gone through. Based on the history you have shared, first of all it is commendable the way you put all the technical details in such pattern that it's really impressive.

Since you are concerned about pulmonary embolism the most, so normally it presents with findings of strain at right heart in labs. This can be judged clinically or at ECG or at Echo as you mentioned about PAP, as well as inability of closure of right sided heart valves due to increased back flow due to obstruction in pulmonary vasculature.

In your case, only tricuspid regurgitation and mild increase in PAP refer to that but with such small regurgitation or borderline rise in PAP massive embolus is less likely.

However at this stage, I would recommend you to have D Dimers which, if normal will exclude pulmonary embolism even at small level and if still in doubt, may need CT Pulmonary Angiogram which will be highly suggestive to exclude any such possibility.

As far as PACs are concerned , heart rate will be of some value, as control of rate would be recommended and electrophysiological studies are needed to confirm any need for electrical or pharmacological intervention.

Wishing you a speedy recovery. Hope this has answered your query, if you have any more questions, feel free to ask.

I must admit it was very nice interacting with you and it felt so good to know the way your are well versed with your disease.

Have a superb health ahead.
Regards.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Saddiq Ulabidin (2 hours later)

I just recently had a CTPA which showed no evidence of pulmonary embolism and normal perfusion. The V/Q scan also showed no pulmonary embolism, normal perfusion, and came back as low probability.

Is there any other reason that could mildly elevate pulmonary pressures, even if they are still within normal range - in other words, can normal pulmonary pressures vary within the normal range? If they can vary, what causes them to vary within a normal range? If there are no pulmonary emboli, can the pulmonary pressures decrease again on a future reading? Thank you.

Answered by Dr. Saddiq Ulabidin (8 minutes later)

Brief Answer:
It can be due to multiple other causes other than pulmonary embolism

Detailed Answer:
Hi! Thanks for the detailed feedback. Well, in that case pumonary embolism is a past story for you. The PAP can be raised due to multiple other causes including lung diseases as well as primary causes due to tightening of pulmonary vessels and 6-7 mm rise is quite insignificant and such minor fluctuations can be found between different ECHO at different times. I would suggest to repeat it after six months to see the trend. If it increased then medications may be started to reduce it. Hope this has answered your question. Regards.

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Above answer was peer-reviewed by : Dr. Yogesh D