Expert Guest Chat Log
Topic: Pulmonary Hypertension
Date: Sunday, June 25, 2000
Guest: Dr. Diane Zwicke of the Milwaukee Heart Institute of Sinai Samaritan Medical Center and St. Luke's Medical Center Pulmonary Hypertension Clinic
<MODERATOR> ***ATTENTION PLEASE!*****
<MODERATOR> ***Welcome to the PHCentral Guest Expert Chat!
<MODERATOR> ***Guest Expert will be Dr. Dianne Zwicke, from
Milwaukee
<MODERATOR> ***Topic: PH Secondary to heart defects and
Family Issues
<MODERATOR> ***The moderator today is Michael Szczepkowski
<MODERATOR> ***Here are the rules for today's chat:
<MODERATOR> ***If you have a question, please send a "?"
<MODERATOR> ***I will keep track of who is next in order and
then....
<MODERATOR> ***call on you to ask your question.
<MODERATOR> ***When you see some text followed by "..." that
means the person...
<MODERATOR> ***still has not finished typing.
<MODERATOR> ***There will be a log for today's chat.
<MODERATOR> ***OK, we are ready to begin. If you have a
question...
<MODERATOR> ***please type and send a "?"
<MODERATOR> Go ahead
<Monica> ?
<Margaret> ?
<MODERATOR> OH, we need to complete the chat in 30
minutes.
<MODERATOR> Monica, go ahead with your question
<Monica> Can heart valve damage cause PH?
<KarenW> ?
<Dr. Zwicke> Yes, various leaky valves can cause PH . . .
<Dr. Zwicke> as well as stenosis of the mitral valve. All of these
unless identified late, are reversible.
<MODERATOR> Monica, do you have a follow-up question?
<Monica> So why do some say tht PH is primary if I have heart
valve damage?
<carrie> "?"
<Dr. Zwicke> If the PH is due to a heart valve problem, it is not
primary, it is a secondary form.
<MODERATOR> Margaret, you are next.
<Margaret> If your pulmonary veins have been scarred because
of past congestive heart failure, is there a chance that ph can be
reversed.
<Dr. Zwicke> In most cases, they can be reversed with
medication therapy.
<MODERATOR> Margaret, do you have a follow-up question?
<Margaret> I have had ph for at least 5 years, what medications
would I need to reverse it?
<Dr. Zwicke> Would be ACE inhibitors, diuretics, sometimes
digoxin, sometimes Flolan, or other vasodilator drug that the
individual would respond to.
<MODERATOR> Karen, your next.
<KarenW> Could an ASD from birth, closed at age 13, cause
SPH diagnosed at age 45?
<Dr. Zwicke> Yes. We do see somoe people who had shunts
closed at appropriate ages . . .
<Dr. Zwicke> develop PH later in life. Nobody understand
exactly why, but it is treated similar to PPH.
<MODERATOR> Karen, do you have a follow-up question?
<KarenW> no
<MODERATOR> Carrie, you are next.
<MODERATOR> Anyone else, If you have a question, please
send a "?"
<carrie> are you aware of any statistical studies that correlate the
large increase in ph with exposure to diet drugs?
<Terri> ?
<Dr. Zwicke> There are several smaller studiees that have been
completed . . .
<Monica> ?
<Dr. Zwicke> that have shown variable results . . .
<Dr. Zwicke> some have supported the relationship between
taking various diet drugs . .
<Dr. Zwicke> and a primary hypertension-type disease.
<Dr. Zwicke> Others have not shown such a clear relationship.
<Dr. Zwicke> There are at least 5 studies that I am aware of to
continue to try to . . .
<Dr. Zwicke> establish this relationship.
<MODERATOR> Carrie, do you have a follow-up?
<carrie> ;thank you.
<MODERATOR> Terri, you are next.
<Terri> i have had sph/copd since oct 99, taking the same
medications since 96. my pressures are not going down and the
sob is worse , my doc keeps saying have to treat the sph . but if
nothing is bringing down the pressures can it be treated with
flolan.
<carrie> could you supply me with the publications sources for
these studies?
<MODERATOR> Carrie, we will come back to your question
<Dr. Zwicke> There are no publication sources that support large
numbers of patients being treated with Flolan for COPD related
SPH.
<SharonSATX> ?
<Dr. Zwicke> There is a subset of COPD patients who have
been found to respond well to FLolan or nitric oxide.
<Dr. Zwicke> There is also a small subset of COPD patients that
respond to CCBs.
<Dr. Zwicke> Each patients needs to be individually challenged
with these medicines during a right heart cath.
<Dr. Zwicke> To determine if it would be helpful to them.
<MODERATOR> Terri, follow-up?
<Terri> you have to treat the ph also not just the secondary
problem
<Dr. Zwicke> The important focus is to treat the underlying
disease first, when that has been maximized, you treat the PH.
<MODERATOR> Monica, you are next
<Monica> I will start ccb's and possibly a diuretic soon and am
worried about potassium loss. Are there any mild forms...
<Terri> thank you
<Monica> of potassium that I could take? I tried it before and it
bothered my stomach
<Dr. Zwicke> There are about 15 different preparations of
potassium . .
<Dr. Zwicke> you need to work with the pharmacist that fiills
your prescriptions .l . .
<Dr. Zwicke> to find the one that bothers your stomach the least.
<MODERATOR> Monica, follow-up?
<Monica> No thanks
<MODERATOR> Sharon you are next
<SharonSATX> I had major surgery (double knee replacement
scheduled prior to being DX'd Apr 2000 w/ pressure of 55. Is it
dangerous to have this surgery now?
<MODERATOR> Anyone else, if you have a question, please
send a "?"
<carrie> "?"
<Dr. Zwicke> A cardiologist or PH specialist should follow you
through your surgery . . .
<Dr. Zwicke> the anesthesiologist needs to know that you have
moderate level PH . . .
<Dr. Zwicke> and they can usually proceed with your surgery
and manage this.
<MODERATOR> Sharon, follow-up?
<SharonSATX> no, thanks
<MODERATOR> Carrie, you are next.
<carrie> Dr Zwicke, could you give some examples of "Family
Issues" and PH?
<KarenW> ?
<Dr. Zwicke> Can you clarify "Family Issues"
<carrie> Well, I meant in relation to the subject for this chat!
<Dr. Zwicke> Dealing with spouse? Children? Work?
Employment?
<carrie> i didn't know what was meant by family issues in this
context.
<Amy Jo> Amy Jo ?
<Margaret> ?
<Dr. Zwicke> We discussed all of the above. Is there a particular
question we can address.
<MODERATOR> Carrie, do you have a family issue question?
<carrie> no, but thank you very much.
<MODERATOR> Karen, you are next.
<KarenW> What are the risks of going through surgery if PH
pressures are 85/35?
<Dr. Zwicke> That depends on the type of surgery . . .
<Dr. Zwicke> depends on the anesthesiologist . . .
<Dr. Zwicke> and the post-operative care.
<MODERATOR> Karen do you have a follow-up?
<KarenW> no thank you
<MODERATOR> Amy Jo, you are next.
<Amy Jo> Would you advise a patient to get a second opinion
from another ph spec if you were told there are no options
available for you?
<SharonSATX> ?
<Dr. Zwicke> I always encourage patients with difficult disease
states to obtain second or third opinions.
<MODERATOR> Amy Jo, do you have a follow-up?
<Amy Jo> Thank you that's what I wanted to hear!
<MODERATOR> Margaret, you are next.
<Margaret> Is there any way of removing scar tissue from
pulmonary veins? Perhaps with the use of laser technology.
<StacyinCO> ?
<carrie> "?"
<Dr. Zwicke> At this point in time, there are no successful
mechanisms that I am aware of . . .
<Dr. Zwicke> laser is a device that is operated by causing a burn
. . .
<Dr. Zwicke> therefore, that would never be useful in this
situation.
<Margaret> Thank you
<Dr. Zwicke> But there are a number of people working on new
research projects . . .
<Dr. Zwicke> of how to treat scar tissue that is already present.
<MODERATOR> Margaret, do you have a follow-up?
<Margaret> yes
<Margaret> What are the new research projects that treat scar
tissue?
<Dr. Zwicke> Ongoing vasodilator studies, and a number of
animal studies looking at injections into the blood vessel walls,
and electrical stimulation of the blood vessel walls. . .
<Dr. Zwicke> the animal studies are not ready to be tried on
humans yet.
<MODERATOR> Sharon, you are next.
<SharonSATX> What do you mean it depends on the
anesthesiologist? How good he is, or what?
<Margaret> Thank you
<Dr. Zwicke> A PH patient that is undergoing a major surgical
procedure . . .
<Dr. Zwicke> needs to have an anesthesiologist that is familar
with and comfortable taking care of PH patients.. .
<Dr. Zwicke> patients can call the anesthesia dept. and speak
with the anesthesiologist that is in charge . . .
<Dr. Zwicke> or assigned to their case before surgery.
<MODERATOR> Sharon, do you have a follow-up?
<SharonSATX> No thanks
<MODERATOR> Only 2 more questions, Stacy and Carrie,
Stacy you are next.
<StacyinCO> My sister died with PH and now I have it what is
the best way for my family to deal with the loss of one daughter
and the fear of losing another?
<Dr. Zwicke> This is a very difficult situation . ..
<Dr. Zwicke> hopefully, the second daughter has been diagnosed
at a stage while she is treatable . . .
<Dr. Zwicke> we have had patients alive up to 15 years on
Flolan, and expecting them to live longer . . .
<Dr. Zwicke> ongoing research is showing us other drug options .
. .
<Dr. Zwicke> so we expect people to be living longer and not
have as bad a prognosis as patients diagnosed earlier.
<MODERATOR> Stacy, follow-up?
<StacyinCO> How concerned should we be that my 18 year old
niece will develop PH?
<Dr. Zwicke> There is some genetic tendency to develop PPH. .
.
<Dr. Zwicke> the best screening study is a cardiac echo . . .
<Dr. Zwicke> and that is a very easy outpatient test she could
have done to put everyone's mind at ease.
<MODERATOR> Carrie, you are next - last question and
follow-up.
<StacyinCO> Thank you
<carrie> At the Mayo Clinic, a Cardiologist gave me a Dx of
"excecise induced pH". Can you explain this?
<carrie> I didn't think excercise caused ph.
<Dr. Zwicke> That means that your pulmonary pressures
increase only when you exercise.
<carrie> ah, thank you.
<Dr. Zwicke> We don't fully understand the long-term
consequences . . .
<Dr. Zwicke> of this. I just recently published the findings of ten
patients who have severe exercise-induced PH. . .
<Dr. Zwicke> that improved after having their mitral valve
replaced.
<MODERATOR> Carrie, follow-up question?
<carrie> no, but i would love to read your study!
<Dr. Zwicke> We'll make sure it is on PHCentral.
<MODERATOR> THANK EVERYONE! Thank you Dr.
Zwicke!
<carrie> Micael, Dr. Zwicke, thank you so much for a great chat.
<MODERATOR> See you everyone!!!
<Amy Jo> Amy Jo Thank you Dr.Zwicke and Michael. Have a
save trip home.
<liz> thank you Michael and Dr. Zwicke
<MODERATOR> Thanks
<Margaret> Thank you Michael and Dr. Zwicke
<SharonSATX> Thanks, everyone
<Dr. Zwicke> Goodbye Mr. Presidednt\
<Earl> good bye all :-)
<KarenW> Good bye everyone
<StacyinCO> Thank you Bye everyone