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Mardi Gomberg-Maitland, MD, MSc, is a fellowship-trained cardiologist and professor of medicine at GW Medicine, who also serves as Medical Director of the Pulmonary Hypertension Program at The George Washington University Hospital (GW Hospital).
Here, she discusses pulmonary hypertension and how GW Hospital can help patients with this condition.
Q: What is pulmonary hypertension?
A: Pulmonary hypertension, or PH, is high pressure in the lungs. It has many causes – anything that can narrow the blood vessels that take blood from the heart to the lungs. The pulmonary arteries can cause high pressure and narrow due to an inflammation or clot. They react to conditions affecting the lungs like pneumonia or emphysema, or the heart, like heart valve diseases or problems with the heart muscle pumping or relaxing
With the lungs, you can’t put on a blood pressure cuff. So, often people don’t really appreciate or understand that it’s different than actual high blood pressure in the body.
Q: How common is PH?
A: We have found over time that many conditions are associated with this narrowing of blood vessels, such as lupus, scleroderma, HIV and hepatitis. When PH develops from other causes, like heart conditions or lung conditions, it’s actually quite common. It is a bit tricky, because it really makes a difference what causes PH in order to say if it’s rare.
Q: What symptoms should people watch for?
A: The symptoms are often just exertional shortness of breath, when you walk up a hill or up stairs. PH can be misdiagnosed because people think it must be asthma or some other condition. If you’re feeling short of breath and spirometry testing doesn’t find asthma, or they give you an inhaler and you’re not feeling any better, you should see a pulmonologist or cardiologist.
The issue is that patients present to us and heart failure is already quite severe. We want to catch PH when they are just having shortness of breath.
We can do a screening echocardiography, which is an ultrasound of the heart. It allows us to look at the heart function and structure and look for other causes and gives us an understanding of what the pump the right ventricle is doing. Ultimately, the diagnosis is made through a right heart catheterization, where we measure the pressures in the heart and lungs and the blood flow to the heart.
Q: Left untreated, what would a patient be facing?
A: If you have narrowing or pulmonary arterial hypertension and it’s not treated, it is fatal. None of the therapies are curative. It’s something that needs to get diagnosed because now we have therapies that can make it more of a chronic condition instead of a death sentence. I have patients that are now 20 years out on medications. We have 14 different FDA-approved therapies to treat the disease.
Q: How is GW Hospital advancing care for PH?
A: At the hospital and on the outpatient side, we have multidisciplinary teams who understand PH and can manage all the intricacies of therapeutics and outpatient care. GW Hospital is the only accredited comprehensive center in Washington, D.C. We’ve come a long way in a short period of time, due to innovation and persistence.
Q: Have the prognoses for PH improved?
A: Yes. I want to caution that when you Google pulmonary hypertension, it doesn’t necessarily mean that you have the severe, rare type. The statistics you’ll find are from when we had no treatment and now our therapies are better and we have options. And, our diagnostics are so much better that we’re identifying more cases. The treatments have allowed better prognoses even for people at the later stages.
Q: How does GW Hospital practice multidisciplinary PH care?
A: The program consists of cardiologists and pulmonologists. We also work closely with interventional radiology. I think what’s important about PH is that even the folks that do well on medications can require hospitalization from colds, the flu, or what would be a mild pneumonia for me or you. The comprehensive nature of the patient education provided by GW Hospital, in addition to the collaborative and outpatient care, really make it a unique place.
Q: Why would you recommend GW Hospital to patients with possible PH?
A: For PH, it’s critical to be at a hospital that is trained and understands the disease state, because patients present in different ways. Being at GW Hospital allows you to feel secure that the nurses, the doctors and the care team understand how to treat your illness.
Let the GW Hospital family care for you and yours.
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