Don’t ignore shortness of breath

Published February 24, 2017


Ronald Zolty, MD, Cardiologist 

Many of us have experienced shortness of breath at some time or another. It’s a common complaint that can be caused by many reasons. But when breathing problems do not go away and get worse with exertion, it should be evaluated. Shortness of breath with exertion is a common symptom of pulmonary hypertension.

Pulmonary hypertension is a life-threatening condition that means you have high blood pressure in the arteries that go from your heart to your lungs. It’s not the same as having regular high blood pressure. With pulmonary hypertension, the tiny arteries in your lungs on the right side of the heart become narrow or blocked, reducing the flow of blood to your lungs. This causes your heart to work harder. If not treated, eventually it will cause the heart to weaken and could lead to heart failure.

“Pulmonary hypertension in its earliest stages is difficult to diagnose because it is often mistaken for heart disease,” says Ronald Zolty, MD, cardiologist at Nebraska Medicine. “But because it doesn’t show up in standard cardiac diagnostic tests, it may be dismissed. Early detection is very important, however. Pulmonary hypertension is a progressive disease. With advances in treatment options, we can stop the progression but we can’t undo the damage.”

In addition to shortness of breath with exertion, other symptoms include fatigue, lower extremity edema and abdominal distention. In more advanced stages, patients may experience dizziness and syncope.

An echocardiogram is typically the first diagnostic test that will be ordered by your physician. The problem, standard echocardiograms typically evaluate the left side of your heart, which is associated with heart attack and high blood pressure. Pulmonary hypertension involves the right side.

“At Nebraska Medicine, we perform a comprehensive evaluation that includes both a left and right side echocardiogram,” says Dr. Zolty. This is followed by blood test to measure the level of fluid retention and heart stretch. These two tests may be negative if the patient is in the earlier stages of the disease. The next test performed is a right side cardiac catheterization with exercise. If exercise induces elevation of the pulmonary pressures, it is likely the patient has pulmonary hypertension. Other tests will then be performed to determine the cause.

“Knowing the cause of this condition is extremely important as this will guide us in how to appropriately treat the patient,” says Dr. Zolty. “When the disease is caught early and treated appropriately, many patients can go on to live a normal lifespan.”

“Eighty percent of patients have very good results,” says Dr. Zolty. “About 5 to 10 percent of patients may not respond to oral therapy and may need more advanced treatments.  Some patients may even be considered for lung or combined heart and lung transplantation.

The most common cause of pulmonary hypertension is heart failure or other types of heart disease like diastolic heart disease or valvular disease. This is followed by lung diseases like emphysema, bronchitis or pulmonary fibrosis;  autoimmune diseases like lupus, scleroderma and rheumatoid arthritis; cirrhosis of the liver, HIV, illegal drug use, congenital heart defects; pulmonary embolism; and diseases like sickle cell anemia and sarcoidosis.  In some cases, it may be idiopathic or familial.

Pulmonary hypertension is more common in men ages 50 and over but it is also seen in young women as early as their 20s or 30s due to genetics, congenital heart defects and connective tissue diseases like sclerodermia.

“This is a disease that affects about 3 percent of the population, but its prevalence is increasing as we see an increase in heart disease,” says Dr. Zolty.

Do you have unexplained shortness of breath? To schedule an appointment for an evaluation, call us at 800-922-0000.