Q: My 40-year-old daughter has just been told she suffers from pulmonary hypertension. She has always watched her weight, exercised, and kept her body healthy. No diet pills. They have ruled out secondary hypertension. She has passed out about three times in the last six months and can get winded just walking a little ways. The doctor decided just to watch her for six months with no meds. Doesn’t she need medicine now to slow down the progression? Doesn’t she need help now?
A. Pulmonary hypertension is a form of high blood pressure that affects the arteries in the lungs and the right side of the heart. It begins when the arteries and capillaries narrow and become blocked, making it more difficult for blood to flow through the lungs. As pressure builds, the right ventricle (lower right chamber) is forced to work harder to pump blood, a process that causes the heart muscle to weaken. Symptoms include fatigue, shortness-of-breath, edema of the extremities, heart palpitations, and syncope (fainting).
Causes for pulmonary hypertension include congestive heart failure, HIV infection, having an autoimmune disorder such as scleroderma, lupus or rheumatoid arthritis, emphysema, chronic bronchitis, clots in the lungs and more. In the majority of cases, the cause can be identified and for some, treatment to lower the blood pressure in the pulmonary arteries can not only help, it may halt the progression of the disorder.
Because you said simply “they ruled out secondary”, I will explain this briefly for other readers. Pulmonary hypertension caused by another medical issue is referred to as secondary pulmonary hypertension that may result from left-sided heart failure, the use of specific stimulant drugs, pulmonary embolism (blood clots in the lungs), sleep apnea, cirrhosis (a chronic liver disease), chronic obstructive pulmonary disease, and numerous other possibilities. Older adults are more likely to develop secondary pulmonary hypertension, while younger individuals will have the pulmonary hypertension your daughter has been diagnosed with.
Diagnosis may be difficult because of a similarity of signs and symptoms with other heart/lung disorders. As a result, testing may begin simply but will likely require more sophisticated testing. Blood tests and X-rays may begin the process. A blood test can check for components within the blood indicative of the disorder. A chest X-ray may appear normal and offer nothing, or it may reveal an enlarged right ventricle. A Doppler echocardiogram will reveal how well the heart is functioning, followed by right heart catheterization or more sophisticated testing.
As I have indicated in the past, there are four classifications of pulmonary hypertension as defined by the World Health Organization. Class I has no symptoms. Class II may present with fatigue, chest pain or shortness of breath during regular activity. Class III will reveal an individual without symptoms when at rest, but obvious symptoms with exercise. Class IV presents with symptoms at rest and during exercise. I am hard-pressed with your minimal information to guess which category your daughter may be in. What is important is that her physician is taking a wait and watch approach. He or she may have a compelling reason to give things six months but that information should be relayed to your daughter so she can understand what’s behind the thought process. It isn’t easy to zero in on the best medication to lessen her symptoms and there may be a reason to withhold drugs at this stage that will require extremely close monitoring. If I were your daughter, I would ask for a referral to a top-notch cardiologist or pulmonologist in your area for a second opinion. She cannot continue to have syncopal episodes that could harm her or someone else.
In the interim, she should refrain from smoking if she even does, stay as active as possible, get adequate rest, reduce stress in her everyday living, and discontinue taking birth control pills if she is using them since they can increase her risk of developing a blood clot.
Other readers who are interested in learning more can order Dr. Gott’s Health Report “Pulmonary disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com. Be sure to mention the title.
