ASK DOCTOR H: Signs can be subtle for pulmonary hypertension

By Dr. Mitchell Hecht

Q: Could you please explain what pulmonary hypertension is? Is it similar to emphysema? — B.R., Decatur

A: Pulmonary hypertension means that there’s too much blood pressure in the pulmonary artery, the blood vessel that carries oxygen-poor blood from the right ventricle to the lungs for

oxygenation. Higher than normal pressures in the right side of the heart and the pulmonary artery can easily be observed by echocardiogram and Doppler flow studies. It’s a complex problem with many causes and a wide degree of severity. It usually leads to enlargement of the heart’s thin-walled right ventricle, right-sided heart failure and irreversible lung damage.

Signs and symptoms of pulmonary hypertension such as fatigue and shortness of breath with exertion are often subtle and nonspecific. Pulmonary hypertension is often found by echocardiogram when symptoms progress or new symptoms such as chest pain or near-fainting emerge.

Most folks develop pulmonary hypertension because of an underlying condition such as emphysema (destruction of the tiny “alveoli” lung sacs where oxygen and carbon dioxide gas exchange occurs), untreated severe sleep apnea, chronic clots, valvular problems like mitral valve narrowing, scleroderma, sarcoidosis or sickle cell disease.

Rarely, folks develop pulmonary hypertension for no clear cause.

Treatment of pulmonary hypertension should first address any contributing disease processes — such as emphysema or obstructive sleep apnea. Next, a cardiologist will decide from among several treatment options that may include calcium channel blood pressure medication to relieve pulmonary blood vessel constriction, digoxin, diuretics, supplemental oxygen and Coumadin. Lung transplantation is a treatment of last resort for folks younger than 65.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.

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