Heart / Lung Connection
Cardiac Unit Fuels Expertise in Pulmonary Hypertension
"The heart and lungs are intimately connected and dramatically influence each other," said Kern Buckner, MD, Chief of Cardiology at National Jewish Health. "Many National Jewish Health patients need care from a cardiologist as well as a pulmonologist." Thousands of patients from around the nation come to National Jewish Health every year, seeking help for their breathing difficulties. It is not always their lungs, however, that cause the problem; the heart and the circulatory system are often involved as well.
So, a lot of times when people come to National Jewish, they get set up to see a heart doctor like myself, and the first question they ask is why am I here? I'm short of breath, and I just saw the lung doctor, isn't it my lungs?
The truth of the matter is, it's very common for people to be short of breath because of both their heart and their lungs, and there's a big interaction between the two of them.
Most people don't realize, but the heart is really two hearts. There's a left heart, which pumps to your brain, your body, your arms, your muscles. And, when we check our blood pressure, this is typically the left side heart pressure that we're measuring. The right side of the heart, however, pumps to the lungs. And, it takes the oxygenated blood and pumps it to the lungs, and then the lungs return it to the left side of the heart.
So, a lot of times when people are sick, if the right side of their heart gets sick because of lung disease, it can even make the left side of their heart sick. And, vice versa, the left side of the heart can make the right side of the heart sick.
And so in general, it's very important to understand that when you're looking at evaluating someone who's short of breath, it's very important to get a careful evaluation of both the heart and the lungs together to put together the whole person.
A lot of times by the time people get to National Jewish, it's usually one more than the other, but a lot of times it's a little bit of both, and it's very important to get those two pieces together.
In 2007, National Jewish Health launched a cardiology division to better care for patients’ common cardiovascular problems. In late 2011, the cardiology division opened a state-of-the-art cardiac catheterization (cardiac cath) unit, which helps physicians evaluate blood flow and pressure in and to the heart.
The unit helps National Jewish Health deliver more comprehensive care on its main campus and is a crucial tool for investigating poorly understood, but potentially deadly pulmonary hypertension.
Pulmonary hypertension occurs when pressure builds up in the arteries in the lungs. (It is different from general hypertension, which involves arteries throughout the body.) That pressure makes it more difficult for the right side of the heart to pump blood through the lungs, which can cause shortness of breath. Over time, the overworked right side of the heart becomes enlarged and can fail.
“Pulmonary hypertension is a common problem among our patients. It can be deadly, but unfortunately often goes unrecognized,” said Dr. Buckner. “Our new cardiac cath unit will allow us to diagnose pulmonary hypertension right here on campus.”
Cardiac cath helped solve the mystery of Deb Adamson’s rapidly failing health, and put her on the road to recovery. She had been diagnosed previously with emphysema. Then three years ago she unexpectedly began putting on significant weight, living with constant chest pain and having increasing difficulty breathing.
The extreme chest pain led to a stint in the hospital where physicians discovered that she had an enlarged heart and diabetes. Doctors suspected pulmonary hypertension.
Cardiac cath is the only way to definitively diagnose pulmonary hypertension. The procedure involves inserting a catheter in a patient’s neck or leg and then threading it through blood vessels to the heart, where blood pressure is directly measured. Cardiologists can make a diagnosis of pulmonary hypertension immediately and the patient is home later that day.
The cardiac cath indicated that Deb Adamson did indeed have pulmonary hypertension. Her National Jewish Health physician, Andrew Freeman, MD, started her on the medication sildenafil to increase blood flow to the lungs.
With her pulmonary hypertension controlled and a handle on her diabetes, Adamson began getting more exercise. She has lost more than 50 pounds and her stamina continues to increase.
Adamson was fortunate that the sildenafil helped her, because there are few treatment options for patients with pulmonary hypertension, especially for the 90 percent of them whose disease arises secondary to their respiratory disease.
Cardiology Division Chief Dr. Buckner sees this as an opportunity.
“With the pulmonary and cardiac expertise at National Jewish Health, a robust population of pulmonary hypertension patients, and the opening of the cardiac cath unit, we are in a great position to make significant advances in the diagnosis and treatment of pulmonary hypertension,” said Dr. Buckner. Drs. Buckner and Brett Fenster are now working on developing a noninvasive method of diagnosing pulmonary hypertension. More research projects are in the planning stages. “This is a big step forward for cardiac care and research at National Jewish Health.”