American Medical Association Family Medical Guide - American Medical Association [350]
Diagnosis
To diagnose pulmonary hypertension, a doctor will take a medical history and perform a physical examination. He or she will order blood tests to determine blood count (see page 145) and to evaluate kidney and liver function. The doctor also will order a chest X-ray to check for an enlarged pulmonary artery, and an echocardiogram (ECG; see page 561), a recording of the electrical activity of the heart, to determine if the heart is enlarged or if it is not pumping efficiently.
Treatment
Treatment of pulmonary hypertension depends on the underlying disorder that is causing it. Daily home treatment with oxygen (which reduces spasms in the pulmonary arteries) sometimes helps lower pulmonary blood pressure. If pulmonary hypertension is caused by chronic lung disease, the goal of long-term treatment is to stop further deterioration of the lungs. Your doctor may prescribe antibiotics and will make sure you get yearly flu shots (see page 145) and a vaccination against pneumonia (see page 145) every 5 to 7 years to help prevent chest infections.
Heart failure caused by pulmonary hypertension can be relieved with rest and treatment with oxygen and diuretics (which eliminate excess fluid from the body). In some cases, vasodilator drugs are effective in reducing blood pressure in the pulmonary arteries by widening the blood vessels.
People who have pulmonary hypertension and progressive heart and lung disease can be treated successfully with a heart and lung transplant (see page 658) or, if the heart has not been damaged, a lung transplant (see page 658). Major surgery of this kind carries substantial risks and is performed only after all other treatments have been unsuccessful.
Heart Muscle and Pericardium Disorders
The walls of the heart are made of muscle that contracts rhythmically about 100,000 times a day. If heart muscle is diseased or damaged, the force of the heartbeat decreases and reduces blood circulation. The term cardiomyopathy is used to refer to several forms of heart muscle disease. In cardiomyopathy, the tiny muscle fibers of the heart are damaged, often from an unknown cause. Over time, this damage decreases the ability of the heart muscle to contract, leading to widening of the ventricles (the pumping chambers of the heart) and eventually to heart failure (see page 570). In some people, the damage is confined to the heart. In other people, other organs are affected as well. Cardiomyopathies generally occur less often than most other types of heart disorders. Although some types of cardiomyopathy run in families, the cause is usually unknown.
Myocarditis
Myocarditis, or inflammation of the heart muscle, is a type of cardiomyopathy that occurs as a rare complication of an infection, usually caused by a virus. In mild cases, the only symptoms may be slight chest pain, shortness of breath, and a rapid pulse. In more severe cases, such as those caused by diphtheria, myocarditis can lead to heart failure (see page 570), third-degree heart block (see page 583), or death.
Diagnosis
If your doctor thinks you may have myocarditis, he or she may order a chest X-ray; an electrocardiogram (ECG; see page 559), a recording of the electrical activity of the heart; and an echocardiogram (see page 561), an ultrasound examination of the heart. You may also have a heart muscle biopsy, in which a small amount of tissue is removed from the heart muscle in a cardiac catheterization procedure (see page 592) and examined under a microscope.
Treatment
Myocarditis is usually caused by a virus, for which there is no specific treatment. The doctor will recommend complete rest. In some cases,