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Pulmonary Hypertension

Diagnosis of PH

05/11/2006

Question:

I am a 44 year old male with Obstructive Sleep Apnea that is being successfully treated. I was probably symptomatic for many years with OSA before diagnosis. I recently had an Echo and my GP has indicated the possibility of PAH, but I do not know the quantitative level of the pulmonary artery pressure. I smoked for 20 years but quit a year ago. I am not overweight and I exercise daily, almost always without symptoms. I exercise for 45 minutes continuously with a HR of 140-160 bpm without shortness of breath. The echo shows an extraction of 75% and I have had a cardio CT with less than 10% calcification. I have flem production and dry throat and am scheduled for full PFT testing. I also had a helical CT of the chest that was normal. I suffer from anxiety (mostly about my health) and my hands (but not my feet) get cold during the day. One year ago I was hospitalized with shortness of breath and a high BP. I immediately began treatment for BP and am on 10mg Altace and taking L-arginine and my overall BP is now very well under control. Is the only definitive diagnosis of PH made by a right side catherization and given my history do you think that PH is a possible diagnosis? If so given my other health history what is the prognosis.

Answer:

It is hard for me to comment on the pulmonary hypertension as I do not know what the echo showed. Also, was it done before or after treatment of OSA?  From your history it seems like you are in good physical condition and do not have any exercise limitations. We frequently find mild elevation of pulmonary pressure on echoes in patients with untreated OSA, which can improve with appropriate treatment.

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Response by:

Namita   Sood, MD, FCCP Namita Sood, MD, FCCP
Associate Professor of Pulmonary, Critical Care & Sleep
College of Medicine
The Ohio State University