Mr. Beeler, a fiftyish guy was perplexed and worried: “I just don’t get it.  My mail box is maybe a hundred feet down the driveway.  Used to be nothing to march down to it, grab the mail and hoof it back and never think about it.  Then I started getting a bit winded on the uphill walk back.  Now I’ve got to stop once on the way down and two or three times on the way back up to catch my breath.  I’ve never even been a smoker; what’s the deal?”

Ok, this one is a bit more complicated, but common enough to be worth knowing something about.  Pulmonary hypertension (PH), which is what Mr. Beeler ended up having, is where the blood pressure in the lung part of the circulation has become elevated.  So, what does that do?  That means the part of the heart that has to pump blood through that higher pressure system has to work harder.  Over time the blood vessels change in ways that cause oxygen to be picked up more and more poorly by the lung’s circulation.  Likewise the right side of the heart that serves as the pump for the lung circulation can get weaker and weaker.

A person developing PH may notice that it takes less and less effort to make them feel quite short of breath.  They may also notice fatigue, chest pain with exertion or even passing out with exertion.  Often they end up needing to be on oxygen to keep their blood oxygen level normal.

The causes of PH are quite varied — everything from heredity to COPD (chronic lung disease) to various heart conditions to a range of medicine and toxin side effects to a further laundry list of causes.  While it is relatively rare in otherwise healthy folks, it can afflict up to 1/4th of people with COPD and one out of five with sleep apnea, just to name a couple of diagnoses.

It is often the shortness of breath that eventually brings people in to get checked by their doctor.  The high pressure in the pulmonary (lung) circulation is often noted on an echocardiogram (an ultrasound of the heart). Other tests such as a heart cath, if needed, can be even more definitive.

Treatment for PH can be challenging.  If there is some specific cause found for it then treating that underlying cause may help.  If it is determined that the PH seems to have developed without some other trigger then there are a number of other treatments that are sometimes helpful in reducing the pressure and improving oxygen levels.  One treatment even involves using the active ingredient in Viagra.  At the far extreme of treatment, lung transplants are occasionally undertaken.  Obviously along the way having a specialist involved can be vital.

So, worsening shortness of breath with exertion is never something to be ignored.  And getting it checked sooner rather than later can sometimes make a significant difference in the success of treatment with several of the causes, including the complicated problem of PH.