Meirish, you are very kind. I am, like you, another retired nurse, but my professional background does include some time in invasive cardiac ICU, so I may have seen this sort of thing more often.
PAH (pulmonary artery hypertension) is elevated pressure in the blood vessel carrying blood from the right ventricle of the heart to the lungs so it can be oxygenated. If the pressure is too high, it holds up the blood getting to the lungs, and as a result it lowers the amount of blood picking up oxygen, and starts a whole cycle of hypoxia, shortness of breath, and increased heart work requirement and heart stress which can in turn increase the pressure. The goal of reducing the right ventricle pressure is to make it easier for the heart to pump blood to pick up oxygen.
RVSP is a measurement of the Right ventricle systolic pressure, and with the Echo, it is a calculated value, not a direct measurement. For actual measurement, you would require the cardiac catheterization. As a calculation, there can be a degree of error, but usually not enough to change your reading from mid range mild elevation to either down to low or up to moderate.
The treatment is often treating any underlying causes, like left heart disease or chronic lung disease, and good old connective tissue disease; which, if they exist, are usually being addressed anyway. Some drugs and toxins can also cause or contribute, and in that case, use of those substances would have to be evaluated to see if they could be discontinued.
Early treatment of PAH without underlying left heart disease or chronic lung disease is usually diuretics, anticoagulants, Digoxin and Oxygen if shortness of breath is an issue. Meanwhile, watch and wait is the usual approach, and your Pulmonologist seems to be doing a good job.
