Fainting, palpitations and mild tricuspid insufficency

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Submitted by Dr T on October 18, 2012 – 10:06am

Hello. I am 30 years old and was admitted to the hospital after suddenly passing out and having heart palpitations with chest pain that radiated to my neck. I have strong family history for CAD and my dad had a heart attack at 49 which resulted in a bypass surgery of 4 arteries. His dad died before 40 years old as a result of a heart attack. I have high cholesterol and am taking lipitor. I had an echocardiogram done and it says that there is a mild tricuspid insufficiency. Pulmonary artery pressure was at 26mmHg. PA systolic pressure was 27.55mmHg. What does this mean? The hospital discharged me with an RX for Nadolol but my primary MD says to hold off on taking it until I see my cardiologist since my BP was 100/65.

Hi Jennifer,
These findings (mild tricuspid insufficiency, Pulmonary artery pressure 26mmHg, PA systolic pressure 27.55mmHg are all a little abnormal), with the insufficiency probavly the result of higher than normal pressures in the arteries to your lungs. It is called mild Pulmonary hypertension (PH). It is unclear to me whether your symptoms are related. There can be many reasons why your pressures may be elevated and in many cases the cause is unknown. In this case, the condition is idiopathic pulmonary arterial hypertension (IPAH). IPAH is rare. It affects more women than men. If pulmonary hypertension is caused by a known medicine or medical condition, it is called secondary pulmonary hypertension.

I agree with your PCP to hold off treatment till you see your cardiologist, assuming this will be soon. Since your condition isn’t serious at this point, the first thing that needs investigation is whether this fainting episode and palpitations have anything to do with these findings. Treatment is determined by the cause of PH and the clinical findings and probably should start with improving your lifestyle (such as cwssation of smoking, weight loss etc.) if possible.
Hope this helps,
Dr T

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