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70 y/o female w/ a PMH of Idiopathic Pulmonary Hypertension (severe), HoTh, Raynauds presents for screening colonoscopy. Had an adenoma removed 7 years prior, GI and primary care want repeat colo. Patient states she is symptomatic with some blood on wiping and intermittent lower abdominal pain. SOB walking up one flight of stairs, able to do ADL, no c/p.
Meds: on amlodipine 5mg, bosentan 125 BID (recently uptitrated), tadalafil 40mg Qday, digoxin, furosemide 20mg qday
Last RHC 2012, PAP 90/30, MPAP 50, systemic pressure 102/70. Last six minute walk test 6 months ago - Spo2 84%, HR 134.
Echo 2017:
1. Normal LV size, mild septal hypertrophy, normal wall motion and systolic function.
2. Nomral LV diastolic function.
3. Left ventricular ejection fraction is approximately 60 to 65%.
4. Mildly enlarged right ventricular size and normal systolic function. (RV/LV ratio 0.83, fractional area change 36 %, TAPSE 2.5 cm, DTI 13.2 cm/s).
5. A prior echo performed on 11/15/2016 was reviewed for comparison. .
6. Mild left atrial enlargement.
7. Mitral sclerosis, with possible mild bileaflet valve prolapse. Mild mitral valve regurgitation.
8. Tricuspid regurgitant jet inadequate to assess pulmonary artery systolic pressure.
Has been scheduled twice in the past 2 years, first anesthesiologist wouldn't do it, second said it would be light sedation and patient would have to raise her hand when uncomfortable (patient refused and left the hospital). Patient called and told high risk of morbidity and death associated with her condition and anesthesia. Wants to proceed anyways due to symptoms and past cancellations.
Safest way to get her through?
Meds: on amlodipine 5mg, bosentan 125 BID (recently uptitrated), tadalafil 40mg Qday, digoxin, furosemide 20mg qday
Last RHC 2012, PAP 90/30, MPAP 50, systemic pressure 102/70. Last six minute walk test 6 months ago - Spo2 84%, HR 134.
Echo 2017:
1. Normal LV size, mild septal hypertrophy, normal wall motion and systolic function.
2. Nomral LV diastolic function.
3. Left ventricular ejection fraction is approximately 60 to 65%.
4. Mildly enlarged right ventricular size and normal systolic function. (RV/LV ratio 0.83, fractional area change 36 %, TAPSE 2.5 cm, DTI 13.2 cm/s).
5. A prior echo performed on 11/15/2016 was reviewed for comparison. .
6. Mild left atrial enlargement.
7. Mitral sclerosis, with possible mild bileaflet valve prolapse. Mild mitral valve regurgitation.
8. Tricuspid regurgitant jet inadequate to assess pulmonary artery systolic pressure.
Has been scheduled twice in the past 2 years, first anesthesiologist wouldn't do it, second said it would be light sedation and patient would have to raise her hand when uncomfortable (patient refused and left the hospital). Patient called and told high risk of morbidity and death associated with her condition and anesthesia. Wants to proceed anyways due to symptoms and past cancellations.
Safest way to get her through?