Question: Hi. Wanted some feedback on my situation. I am a 49 yo WF. I have a coagulopathy which caused in second PE on July 9th. I recovered well after 1st PE 6 yrs ago. This time, I continue to have worsening SOB, especially with very limited activity. I can't get 3/4 way up my stairs or vacuum my livingroom, or laundry without becoming SOB. I'm often SOB talking. My hematologist sent me to my cardiologist since I have been complaining of left sided CP and I'm w/o 2 cardiac valuations ('95, '06). He ordered a nuclear stress test which he said showed an EF off ,44% but he thought that was a artifact. He then ordered a TTE with contrast with the following findings:

Procedure info: This test was a technically difficult study. Views were limited by poor acoustic availability.

Left Ventricle: systolic function at lower limits of normal by visual assessment. EF estimated in the 50% to 55% range. Wall thickness was normal. There was fusion of early and atrial contributions to ventricular filling. Indeterminate diastolic function.

Right ventricle: mild dilating. Systolic function was low normal. Est peak pressure was 40 to 45%.

Right atrium: mildly dilated.

Left atrium: size upper limits of normal. Vol index was 33.

Mitral valve: normal structure with mild regurgitation.

Aortic valve: tripartite with mild increased thickness. No significant regurgitation.

Tricuspid valve: normal structure. Mild regurgitation. Right atrial pressure est: 5-10 moNth.

Pullbox valve: not well visualized.

Systemic veins: IVC: the inferior vena cava was normal in size. Respirophasic changes were blunted ( less than 50% variation) .

As I read this, it appears as possible early heart failure and given the poor visual acoustics, is it reasonable too ask for a TEE? Could this be related to possible pulmonary hypertension?

Yes. My cardiologist, however, thinks nothing of it. He drew a NT-Non BNP which came back at 583. Table stated in pts 50 or less, 0-450 was nrml and above that upper limit, there was an indication of heart failure.

Today, I was in the therapy pool doing my back PT and ... something happened. I felt SOB before hand and the lifeguard said she saw my head loll backward. Bottom line, they fished me out, sent me by ambulance to the hospital. They repeated CT with contrast - no evidence of new PE. The ER doc said they don't worry about NT-non BNPs until they were in the thousands. Of note, I'm s/p 2 cardiac Ablations. The first was done '95 due to AV node reentry. The second was done in '06 for multifocal atrial tach. My interventional cardiologist "set" my HR between 68-70. Only strenuous exercise changes that to around 100 bpm. I mention this because my HR hung around 50 the whole afternoon in the ER with mostly average BPs. Pulse Ox ranged from 91-98. Remain SOB at home now.

I had my first PEs in 2010 and bounced right back. I'm a clinical pharmacist and monitor INRs weekly at home. Told I had protein S disorder which I had been told years ago during my residency. My latest PE was July 9th. My SOB has been worsening. I wake up with it and have to sleep on multiple pilllows.

My aunt is an internist in MA and my friend is NP who has done stress tests for a large part of her career. They both are telling me to get a 2nd opinion at the local University Medical Center.

I am physically and emotionally exhausted. Is there any utility in seeing what another cardiologist thinks? I am very aware of stepping on professional toes but I am desperate to get back to work and know if I have aNY other limitations.