Ask the Doctors September 2017 Issue

Ask the Doctors: September 2017

Recently I was told that I have pulmonary hypertension. What is it and what can I expect in terms of testing and treatment?

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Pulmonary hypertension (PH) is increased pressure in the arteries in the lungs and right side of the heart often due to inflammation and changes in the cells that line the arteries, making it hard for the heart to push blood through them into the lungs. As the pressure builds, the heart’s right pumping chamber (right ventricle) must work harder, eventually causing the heart muscle to weaken and fail. Symptoms include shortness of breath, fatigue, dizziness, chest pain, leg swelling and palpitations. Complications may include right-sided heart failure, blood clots, arrhythmia, and bleeding into the lungs. Diagnostic tests including chest X-ray, echocardiogram, EKG, right heart catheterization, CT or MRI scans, lung function tests, lung scan, sleep study and exercise testing may be obtained to better understand the cause and severity.

PH is classified by cause. Group 1, or primary pulmonary arterial hypertension, is less common and due to unknown reasons (idiopathic), inherited, or secondary to drugs/toxins, connective tissue diseases, liver disease or congenital heart disease. Groups 2 through 5 are more common and secondary to heart disease, lung diseases/sleep apnea, blood clots and other diseases such as sickle cell disease or sarcoidosis, respectively.

Although many forms of PH aren’t curable, treatment can help lessen symptoms, slow the progression of the disease and improve quality of life. Treatment will depend on the type of PH and its severity. First is to identify and treat underlying causes. Treatment for most forms of PH may include diuretics, blood thinners, oxygen therapy and physical activity. More specialized treatments include blood vessel dilators—either IV epoprostenol (Flolan®) or inhaled iloprost (Ventavis®), the endothelin receptor antagonist bosentan (Tracleer®), sidenafil (Revatio®), and high-dose calcium channel blockers such as diltiazem. In severe cases lung transplant may be considered. Each person with PH is different. There are good treatments available. Work with your doctor or a PH specialist.

I have had a coronary stent and have elevated cholesterol. My doctor has recommended the Mediterranean diet. What is it and can it help me?

The Mediterranean diet may be the right heart-healthy diet for you. Research has shown that following this diet reduces bad oxidized LDL cholesterol, may enhance the protective benefits of HDL cholesterol, and reduces the risk of heart disease, stroke, obesity and diabetes. An analysis of 1.5 million healthy adults on this diet was associated with reduced cardiovascular and overall mortality. A recent study reported that those following a Mediterranean type meal plan were a third less likely to die early compared to those consuming a Western diet.

There is no one “Mediterranean” diet, but it is a style of eating based on the cuisine in multiple Mediterranean countries. Simply put: Consume fresh produce and healthy fats. The principles are: 1) Eat primarily plant-based foods, such as fresh fruits and vegetables, legumes, whole grains, and nuts in moderation while avoiding processed foods; 2) Make wise choices in fat consumption by eliminating trans-fat and replacing butter and most oils with more healthy fats, such as extra-virgin olive oil, nuts, seeds and avocado, in moderation; 3) Flavor foods with herbs and spices other than salt; 4) Limit red meats, and in its place eat fish rich in omega-3 fatty acids, such as tuna or salmon, poultry or let grains, beans, vegetables and fruits make up the bulk of calories in the meal; 5) Choose low-fat dairy and switch to skim milk, fat-free yogurt and low-fat cheese; and 6) if OK with your doctor, drink wine in moderation. It’s a healthy and delicious way to eat.

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