New Rush clinic brings trained clinicians to care for patients with pulmonary hypertension

Cardiologists and pulmonologists at Rush University Medical Center have teamed up to provide a new and better approach to treating patients with pulmonary hypertension, a disease affecting the heart and lungs. The new Rush Pulmonary Hypertension Clinic brings together a multidisciplinary team of clinicians with specialized training to care for patients with this very complex disease.

Pulmonary hypertension is high pressure in the arteries that lead from the heart to the lungs. Due to the high pressure, the right ventricle of the heart must pump harder, ultimately causing heart failure or other potentially fatal complications. A diagnosis of pulmonary hypertension once meant a very dire prognosis. However, recent advances in the diagnosis and management of this complex disease have changed outcomes dramatically.

"In the 25 years since I started my practice," says Dr. James Calvin, director of the Section of Cardiology at Rush, "treatments for pulmonary hypertension have come a long way. There are new guidelines, new research and more is becoming known about pulmonary hypertension; but it is not so common that all physicians are aware of the latest treatments and drugs."

Pulmonary hypertension can be difficult to diagnose because its symptoms are nonspecific and mimic the symptoms of other lung or heart disease. Sixty percent of patients will have shortness of breath as the initial symptom. Other symptoms include fatigue, chest pain, syncope (fainting), palpitations and leg swelling.

When there is reason to suspect pulmonary hypertension based on symptoms, the first test used in diagnosing the condition is an echocardiogram, followed by a right heart catheterization to measure pulmonary arterial pressure. To determine what is causing the elevated pressure and how severe it is, patients may undergo additional tests including CT scan, cardiac MRI, pulmonary function and lab work.

The illness stems from a broad range of problems, including heart attack, lung disease, and HIV. Treatment is very complex and may include surgery and a variety of medications, including recently developed oral therapies that widen blood vessels or stop them from narrowing. These oral therapies, Calvin says, represent an important advance in treatment, freeing many patients from medications that had to be continuously administered intravenously.

To address the many complexities of pulmonary hypertension, the new clinic pools the resources of Dr. Calvin, Dr. Rajive Tandon, a pulmonologist, and Dr. Claudia Gidea, a cardiac imaging specialist.

Patients can meet with a cardiologist and a pulmonologist on the same day, in the same office. This arrangement enables the physicians to work in consultation with each other, providing patients with care that comprehensively addresses their various causes of their illness.

"Because the disease is so complicated, it's likely patients will have problems that require more than one specialist," Calvin says. "Now, with the clinic, we can put our heads together to come up with a solution."

The clinic allows doctors to diagnose the cause and severity of the disease and administer treatment more quickly and effectively than they otherwise could. "The patient can see the exact right person at the exact right time," Tandon says. "And that's important because patients' time is very precious."

"The idea of the clinic is more than just medical," Calvin says. "It's about managing the disease in the long term."