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Although it may not seem like a condition that would normally be treated by a cardiologist, pulmonary hypertension is a fairly common condition treated by physicians who are specialized in cardiology. Pulmonary hypertension is most simply described as high blood pressure in the artery leading to the lungs. Its symptoms normally include shortness of breath (known as dyspnea), dizziness, and fainting, and all of these are normally more pronounced while the patient is exerting himself. Because pulmonary hypertension can lead to heart failure, cardiologists are the physicians involved with diagnosis and treatment in most cases.
The condition is normally detected and diagnosed when patients exhibit a loud pulmonic valve closure, evidence of an enlarged right ventricle, and the presence of sustained elevation in the average pulmonary pressure. Usually, the threshold for concern is when the pulmonary artery pressure is greater than 25 mm Hg while the patient is resting. In the United States at least, the most common cause for pulmonary hypertension is left-sided heart disease or chronic lung disease. It is estimated that anywhere between 50,000 and 100,000 patients suffer from the condition but that only 15-25,000 are accurately diagnosed and treated.
There are several causes for pulmonary hypertension. As mentioned above, two of these are left-sided heart disease and chronic lung conditions. In patients with left-sided heart disease, the increased pressure on the left side of the heart can lead to passive congestion and then increased blood pressure to the capillary area of the lungs. In cases of lung disease, several factors may be involved. For one thing, infection can trigger lessened areas of the pulmonary vascular bed to be available – this disruption puts more pressure on the capillaries and reduces the usable surface area of the lungs. Another cause of pulmonary hypertension is a pulmonary embolism or blood clot – unfortunately, in this case, approximately 20-40%, the outcome is death.
Pulmonary hypertension is usually poorly recognized; the most challenging aspect of the disease is often said to be making an early diagnosis. For the majority of patients, it’s estimated that it takes about two and a half years from the time symptoms first appear to the time that the illness is properly diagnosed. Normally, patients start out by experiencing only fatigue and some light-headedness. Occasionally, patients also report some chest pain or dizziness brought on by exercise – all symptoms that many not appear serious at first. Conditions like this are part of what make cardiology jobs so challenging – it is often like a mystery that must be solved.
To accurately detect pulmonary hypertension, a physician can use chest x-rays, echocardiography, and oxygen saturation measurements to check the status of lung functioning. Other commonly used tests include sleep testing, a CT scan of the chest area, and blood tests to look for thyroid problems, HIV, and liver disease. Once a diagnosis has been made, further recommendations for control measures can be proposed. Generally, the goal for the patient is to control symptoms well enough so that regular activities can be undertaken with less risk to the heart.
Exercise is one remedy that patients can undertake so long as they do not engage in strenuous activities. Regular exercise that is tailored to their condition can provide cardiovascular benefits and help maintain the condition of the patients’ muscle mass. Supplemental oxygen is another treatment that can be useful in some patients, as well as anticoagulant therapy. Digoxin is another drug that can help to improve heart arrhythmias or right-sided heart problems. Vasodilators may be useful as well. All of these treatments are part of the normal process in physicians’ practice; cardiology jobs involve treating pulmonary hypertension along with a host of other diseases and abnormalities.
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