Why do I need a right heart catherization?

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Submitted by Dr T on April 2, 2011 – 6:36am

Question: 
I am a 43yr. female.  I have a pacemaker, due to an AV ablation, so I am dependant on my pacer. I recently had an echocardiogram, and will soon have a right heart cath. and venogram.  I was wondering if you could help me to understand the results of my echocardiogram:
Left ventricle: Abnormal
LV size: normal
LV other:  marked eccentric remodeling
LV function:  normal
RV:  diastolic RV volume overload
Aortic valve and mitral valve had trace to mild comments.
Tricuspid valve:  Abnormal
Tricuspid:  normal structure
TV comments:  Estimated PA 48, assume RA 10
IVC:  mildly dialated.
Could you comment on these results?  They are looking for the cause of the pulmonary hypertension.  How can they tell what the cause is with a right heart cath.  I have blockages in upper veins, that is why the venogram is ordered.  Also, if the remodeling is due to pacing with this become worse?  I have marked edema, low excercize tolerance, shortness of breath, and syncope.  I am on coumadin, diuretics, midodrine, potassium. Thank you so much for your time.

A cardiac ECHO can only demonstrate the consequences  of Pulmonary Hypertension (PH) in your heart. Although there are constant efforts to expand and improve its use, to my knowledge (I am a cardiac surgeon and not an ECHO specialist), the next step indeed includes a right heart catherization, as well as a host of other tests (see below).
Do you know why you have blockage in your “upper veins”? One explanation includes damage from lots of previously inserted catheters, others from other causes for thrombosis. As such, I am concerned your PH may involve a prior pulmonary embolism.
Other than that, the ablation may have involved lots of catheter insertions, and now has caused complete heart block, I don’t think it has anything to do with your PH. You can read more here, including possible treatment choices:

Hope this helps,

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