Michael S. Eggert, M.D., provides an in-depth look at the nationally certified Pulmonary Hypertension Program at Sentara, by defining what is PAH, and how it is diagnosed, treated and managed by the exceptional multi-disciplinary team at Sentara Norfolk General Hospital.
My name is Michael eggert. Um I am on the staff of Sentara heart hospital in Sentara Norfolk general, where I'm in the practice of pulmonary and critical care medicine, pulmonary hypertension is exactly what it sounds like in terms of uh lung high blood pressure that often happens as a disease of resistance and flow from the right side of your heart to the left side of your heart. The way blood pumps normally, it has to come to the right side of the heart after return from the body has to go through the lungs to pick up oxygen and they get pumped out of the left side of the heart to get oxygen to the rest of the body pulmonary hypertension. The specific type of disease that I deal with often means that the blood cannot go as effectively from the right side of the heart to the left side of the heart because the plumbing in between is impaired or not functioning right. For some reason, often that reason in my case is because they're the pipes are malfunctioning and there's more resistance to flow from the right side of the heart to the left. The most important screening test for this is echocardiography. So, an echocardiogram um there are particular patient populations that are very vulnerable to pulmonary hypertension, mostly in connective tissue disease, mostly in the room in a logic space. So patients with scleroderma crucially important that they get enable screenings with echocardiography to identify pulmonary hypertension or pre pulmonary hypertension. In addition, mixed connective tissue disease and systemic lupus or other rheumatologist diagnoses that warrant careful observation for development of pulmonary hypertension? In addition, the HIV population does have a small incidence of recurrent pulmonary hypertension, as do those with cirrhosis. In addition, patients who have had congenital heart disease and have had some sort of who have had some sort of corrective surgery or who may not have had corrective surgery can develop pulmonary hypertension or resistance from blood of blood flow from my left and so those are the populations that I like to make sure that the internal medicine population and family medicine population who are taking care of them as outpatients that they screen for this periodically so that can be caught early and diagnosed and treated appropriately in terms of after you perform echocardiography. There is a standard test performed for all pulmonary hypertension patients called right heart catheterization. That's a procedure done daily here at Sentara heart hospital, where a small catheter is inserted either through a vein in your arm or a vein in your neck. At which point we actually measure the pressures in the lungs. So if it's lung, if it's pulmonary hypertension, you'd like to measure the pressure is where you think the problem is once that's obtained as treatment strategy is selected for you based upon a number of a number of pieces of data to include how do you feel? How breathless are you? What can you do? Can you go up a flight of stairs without assistance or a short of breath doing things around the house at home? Do you have other signs of complications of pulmonary hypertension, including right sided heart dysfunction, which can show up as swelling either on your abdomen or in your legs. Do you have blood marker, evidence of stress on the right side of your heart and how far can you walk in six minutes? These are commonly used markers to decide how sick a patient is an initial presentation and then following them over time, we we strive for the patient who uh we can get to a uh we can get to a level called functional class two, which means that they can do almost anything they want and are only limited by significant exertion. The pulmonary hypertension program here at Sentara has grown over the years since 2004. In the initial identification of that father daughter group to a program now of over 700 patients that is nationally certified by the pulmonary hypertension association. And so when we take a patient into our program, it's a multidisciplinary approach that involves interactions with cardiology, pulmonary pulmonary hypertension staff, uh the cardiac catheterization lab staff as well as nursing nutrition palliative care uh and anti coagulation. Should that be needed. So we like to think that we approach the patient holistically and trying to take care of all sorts of clinical and non clinical issues. As many people know pulmonary hypertension is a progressive and incurable disease? And it's crucially important that that patient is maximally treated but also has a maximum amount of support in terms of dealing with a potential fatal diagnosis. What I'd like to say in closing is that I've developed helped to develop this program with a number of wonderful nurse educators, partners and administration, as well as my own partners in Sentara medical, pulmonary and critical care medicine. Um, this is my calling. This is what I am here to do. Um, I approach it with my passion and um, there is nothing better for me than seeing a patient who comes in seriously ill with pulmonary hypertension about from other physicians. May say, I'm not really sure how you're gonna fix that patient and to be escorting them out of the hospital, under their own, under their own ages, without a wheelchair and on room air, feeling better than ever. Better than they ever thought they could