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Underlying condition causes hypertension Ask Dr. H Dr. Mitchell Hecht

Q: Could you please explain what pulmonary hypertension is? Is it similar to emphysema?

A: Pulmonary hypertension means that there’s too much blood pressure in the pulmonary artery, the blood vessel which carries oxygen-poor blood from the right ventricle to the lungs for oxygenation. Higher than normal pressures in the right side of the heart and the pulmonary artery can easily be observed by echocardiogram and Doppler flow studies. It’s a complex problem with many causes and a wide degree of severity. It usually leads to enlargement of the heart’s thin-walled right ventricle, right-sided heart failure and irreversible lung damage.

Signs and symptoms of pulmonary hypertension like fatigue and shortness of breath with exertion are often subtle and non-specific. Pulmonary hypertension is often found by echocardiogram when symptoms progress or new symptoms like chest pain or near-fainting emerge.

Most folks develop pulmonary hypertension because of an underlying condition like emphysema (destruction of the tiny “alveoli” lung sacs where oxygen and carbon dioxide gas exchange occurs), untreated severe sleep apnea, chronic clots, valvular problems like mitral valve narrowing, scleroderma, sarcoidosis or sickle cell disease.

Rarely, folks develop pulmonary hypertension for no clear cause.

Treatment of pulmonary hypertension should first address any contributing disease processes — like emphysema or obstructive sleep apnea. Next, a cardiologist will decide from among several treatment options that may include calcium channel blood pressure medication to relieve pulmonary blood vessel constriction; digoxin, diuretics, supplemental oxygen and Coumadin. Lung transplantation is a treatment of last resort for folks younger than 65.

Q: The skin on my fingertips is getting so delicate that the least twisting of a bottle cap results in a small cut. I cook dinner every night and bake cakes, which is quite a bit of wear and tear on my fingers. I try to be careful when using a knife, and wash my hands many times a day. Is there something I can do to make my skin “tough”?

A: Washing your hands might be good for controlling the spread of germs, but it’s also hard on your skin. The hot tap water and detergent soap are stripping the oils from your skin and drying it out. Additionally, the dryness of winter and the handling of deodorant shower soaps (e.g., Coast, Dial, Irish Spring and Ivory) that aren’t moisturizing make the situation even worse.

My recommendations are as follows: 1) Avoid long hot showers (they dry out skin and strip away the oils that keep skin moist); 2) Use a moisturizing shower soap like Dove; 3) Use gloves when washing dishes; 4) Use an excellent hand lotion such as Neutrogena Deep Moisture Hand Cream, Bert’s Bees Shea Butter Hand Repair Creme, Aquaphor Healing Ointment or a lanolin-based lotion; 4) Use a liquid bandage product or Neosporin for bad splits in skin; 5) Use humidifiers in your home during the dry months of winter; and 6) Take extra zinc and vitamin C to help with collagen repair.

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