UPMC On Topic
Pulmonary Hypertension
Michael Mathier, MD
Co-Director, Comprehensive Pulmonary Hypertension Program
Mark Gladwin, MD
Chief, Division of Pulmonary, Allergy, and Critical Care Medicine
Comprehensive treatment for a complex disease
Pulmonary hypertension is, simply put, high blood pressure in the lungs. It can lead to aggressive problems with your ability to exercise. It can lead to progressive shortness of breath, and, ultimately it can lead to a type of heart failure called “right-heart failure.”
Probably the most common thing Mike and I see are patients coming from the outside, where they might have mixed disease. They might have a little bit of lung disease, a little bit of heart disease, and they also have high blood pressure in the lungs. And their lung doctor has told them it’s a heart problem, their heart doctor’s told them it’s a lung problem, and they get bounced between clinics.
We decided to establish a comprehensive clinic, where heart doctors and lung doctors would simultaneously see patients, give a joint assessment, and form a plan together, so that a patient can get a truly integrated approach to their disease.
Living with pulmonary hypertension
I have many patients with pulmonary hypertension who lead perfectly full and active lives. They’ve been fortunate enough to have a diagnosis made relatively early in the course of their disease. We’ve been able to get them on appropriate therapy — usually just oral medications. They can go to work, they can do their shopping, their chores around the house.
Others are more limited by their disease, but we’ve still been able to, using the medications available, using some guidelines regarding exercise training to improve their functions, so that they can do better than they had been doing.
But on the other side we’re very aggressive about people with severe disease. We have multiple clinical trials where we add multiple combinations of medicine to try to improve their function. And when that fails, we have the strong backbone of lung transplantation.
At UPMC, as high as 30 percent of our patients that we see and transplant were rejected in other centers. And the reason we’re able to offer these lung transplants for the sickest of patients is because we’re such a high-volume center. We have such experienced surgeons and such experienced lung transplant specialists.
An integrated approach to a complex condition
It is very common that poor communication between specialists who are in different fields limits the ability to come to the proper diagnosis of a patient, limits the ability to consider all the possible therapeutic options that are available, and therefore, of course, limits the ability to give the best treatment possible. The integration that we put in place by having cardiologists and pulmonologists working side-by-side simultaneously on these complex patients is really changing the way that we diagnose this condition and changing the way that we treat it.