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Pulmonary Hypertension

Confused about my PH diagnosis

08/03/2011

Question:

I am a 41 year old female runner. I have been running for almost 20 years (including completing 11 marathons and 20 half marathons) and a few years ago I started having shortness of breath while running. My family doctor send me to pulmonary specialist who tested me for asthma and exercise induced asthma. Neither which I apparently have. I was then sent for a stress test and an echocardiography by the specialist. The stress test showed some irregulars but nothing that anyone was too concerned about. The pulmonary specialist told me that the echocardiography showed that I had minor pulmonary hypertension. He also said that it also probably primary. And since I was scheduled to run a half marathon in a few weeks, he decided to check my heart and oxygen levels during exercise. He told me everything was OK and wished me luck in my run. I went to a cardiaologist for a second opinion; who requested another echocardiography and told me that I was fine. I have gone from training for marathon distance to not being able to run more than 3 kms. At about the 3km point, I start having difficult breathing. I run with a heart rate monitor and I find it`s a little high at an average of 160 beats per minute espcially since I have slowed by pace by almost a minute per km. I am tired all the time but my family doctor says it could also be my endometriosis, my feet swell by the end of the day (worse in the summer) and I sweat alot. My doctor prescribed symbicort to help with my shortness of breath while running even though I don`t have asthma. I used to run an average of 50-75kms per week, lately I have trouble getting 15kms.

My questions are: 1) is it possible that I have pulmonary hypertension 2) Symbicort does not seem to be helping, should I stop taking it. 3) I don`t want to stop running but I am really frustrated. What should I do, should I continue to run? 4) What are my next steps. Should I see another pulmonary specialist even though I got a second opinion from a cardiologist? 5) If I don`t have HP, what is happening when I run that I can`t get past 3kms.

Totally Confused.

Answer:

Thank you for visiting NetWellness. NetWellness is a patient education website that provides general information but not individual advice. Unfortunately, your questions fall outside the scope of this service. 

I will apologize in advance since I cannot make specific recommendations without the full set of information available to your physician including exam. 

In general, the concerns of an "elite athlete" or highly trained individual can be challenging. Failure to perform at previous levels without obvious interval changes in regimen etc. may be an early sign of a medical condition. As I have mentioned before, issues of exercise intolerance or breathlessness which are not well explained deserve investigation to a satisfactory resolution or explanation. As always, it is important to review and discuss any aspects of your healthcare or testing with your physician which you do not understand or have questions about. It is important in these discussions to voice your specific concerns and questions. 

General testing to investigate unexplained exercise intolerance may include bloodwork to exclude non-cardio-pulmonary causes of breathlessness or exercise intolerance such as anemia, kidney dysfunction or thyroid dysfunction (among others). It appears as though you may have had some testing of heart and lung function which is also frequently indicated. If this is unrevealing, advanced testing during exercise to include measurements of lung or heart function may be of great value in the diagnosis of exercise- induced or associated problems. This type of testing may even include exercise during heart catheterization with other maneuvers to uncover problems. This type of testing however is not routinely available and often requires referral. 

If there are questions of pulmonary hypertension with or without exercise, national and international guidelines suggest consultation at an advanced center specializing in pulmonary hypertension diagnosis, management and research. There is usually such a center in most states or regions.

For more information:

Go to the Pulmonary Hypertension health topic, where you can:

Response by:

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University