Pulmonary Hypertension

Pulmonary hypertension linked to other heart or lung conditions is fairly common, especially in older adults. Some rare forms affect younger people, often women.

Pulmonary hypertension is sorted by what's causing it. In plain terms, the main causes are:

• Heart causes: problems on the left side of the heart, such as heart failure or valve disease. This is the most common cause.
• Lung causes: lung disease or low oxygen, such as COPD, lung scarring or sleep apnea.
• Blood clot causes: old blood clots in the lungs that didn't fully clear.
• Problems in the lung arteries themselves: sometimes inherited, linked to other diseases or certain drugs, or with no known cause.
• Other causes: some blood, kidney or metabolic conditions.

• Left-sided heart failure or heart valve disease
• COPD, lung scarring (interstitial lung disease) or sleep apnea
• Past blood clots in the lungs
• Connective tissue diseases such as scleroderma or lupus
• Family history, certain drugs or stimulants, liver disease, HIV, or sickle cell disease
• Living at high altitude

Symptoms often start slowly and are easy to blame on other things:

• Shortness of breath, first with activity, later at rest
• Feeling very tired
• Dizziness or fainting, especially with activity
• Chest pressure or pain
• Swelling in the ankles, legs or belly
• A racing heartbeat
• At your visit, your provider checks your oxygen level and listens to your heart for a loud second heart sound or a murmur. They look at the veins in your neck, feel your liver and check your legs and belly for swelling, and look for bluish lips or fingers.

An echocardiogram (heart ultrasound) is usually the first test to estimate lung pressure. Confirming the diagnosis usually needs a right heart catheterization done by a specialist.

Lab tests your provider may order include: BNP or NT-proBNP (shows strain on the heart), a comprehensive metabolic panel (checks kidney and liver function), a complete blood count (looks for anemia or thick blood), thyroid tests (thyroid problems can play a role), HIV and hepatitis tests (these infections can be linked to it), and autoimmune tests such as ANA (to look for conditions like lupus or scleroderma).

Other tests may include an ECG, breathing tests, a sleep study, a lung scan (V/Q scan), chest CT or a walking test. We don't do X-rays or other imaging at our office; we refer you to a trusted outside center or specialist and review the results with you.

Treatment depends on the type and cause:

• Treating the cause: heart failure, valve disease, COPD, sleep apnea or blood clots.
• Oxygen if your levels are low.
• Water pills (diuretics) to reduce swelling, and sometimes blood thinners.
• For problems in the lung arteries themselves (pulmonary arterial hypertension), special medicines prescribed by a pulmonary hypertension specialist.
• Staying active within safe limits, often with pulmonary rehab.
• Avoiding high altitude without advice, and talking with your provider before pregnancy.

Pulmonary hypertension is a serious, long-term condition. How it goes depends a lot on the cause and how early it's found.

Treatment can help symptoms and slow it down for many people. Regular follow-up with your care team is important. No one can promise a specific result.

Your primary care team at Moaddel Medical looks for causes of your symptoms, orders tests and treats related conditions like heart failure, COPD and sleep apnea.

We refer you to pulmonology, cardiology and pulmonary hypertension specialists when needed and keep your care coordinated.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.