What is the best next step in managing a patient with exertional dyspnea and a history of elevated right ventricular systolic pressure (RVSP)?

From the Guidelines

The best next step in managing a patient with exertional dyspnea and a history of elevated right ventricular systolic pressure (RVSP) is to order a new 2D echo with right heart protocol to reevaluate the patient's condition and assess for any changes in RVSP or right ventricular function. To further guide the management of this patient, a comprehensive evaluation should be performed, including a review of symptoms, assessment of risk factors for pulmonary hypertension, and routine studies such as a CBC, comprehensive metabolic panel, thyroid function, and N-terminal pro B-type natriuretic peptide (NT-proBNP) 1. The patient's history of elevated RVSP in the 50's warrants a thorough investigation to determine the underlying cause of the exertional dyspnea, and the new 2D echo with right heart protocol will provide valuable information to guide further management, which may include additional testing such as pulmonary function tests, a six-minute walk test, or right heart catheterization 1. Key considerations in the management of this patient include:

• Assessing for underlying conditions that may be contributing to the elevated RVSP, such as congenital heart disease, autoimmune diseases, or thromboembolic disease 1
• Evaluating the patient's functional class and other co-morbid conditions to determine the best course of treatment
• Considering the use of vasodilator therapies, such as phosphodiesterase-5 inhibitors or endothelin receptor antagonists, if pulmonary arterial hypertension is diagnosed 1.

From the Research

Plan for Ordering 2D Echo with Right Heart Protocol

• The plan for the patient with exertional dyspnea and a history of elevated right ventricular systolic pressure (RVSP) is to order a new 2D echo with right heart protocol to reevaluate the patient's condition, as the previous 2D echo showed elevated RVSP in the 50's 2, 3.
• The new 2D echo will help to assess the current RVSP and other right heart parameters, such as right atrial enlargement, pulmonary artery enlargement, RV enlargement, and RV dysfunction, to determine the best course of management for the patient 4, 5.