Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
High blood pressure in the pulmonary artery that
conveys blood from the right ventricle to the lungs. The pressure in the
pulmonary artery is normally low compared to that in the aorta. Pulmonary
hypertension can irrevocably damage the lungs and cause failure of the right
ventricle.
Pulmonary hypertension is conventionally divided into primary and secondary
types. Primary pulmonary hypertension is considered idiopathic (of unknown
origin). It occurs sporadically with no family history of the disorder and in a
familial form.
Secondary pulmonary hypertension may be due to congenital heart disease,
pulmonary embolism, portal hypertension, collagen vascular disorders (such as
lupus), sarcoidosis, and HIV infection.
The goals of treatment for pulmonary hypertension are to treat the underlying
cause, to reduce symptoms and improve quality of life, to slow the growth of the
smooth muscle cells and the development of blood clots; and to increase the
supply of blood and oxygen to the heart, while reducing its workload. Treatments
include medications, oxygen, and lung transplant. The main medications for
pulmonary hypertension include:
anticoagulants (to reduce the formation of blood clots);
calcium channel blockers, which relax blood vessels and increase the supply
of blood and oxygen to the heart, while reducing its workload;
continuous intravenous epoprostenol (prostacyclin currently considered the
most effective therapy) which widens the lung arteries and prevents blood clot
formation;
treprostinil, another prostacyclin, also relaxes blood vessels and
increases the supply of blood to the lungs, reducing the workload of the heart;
bosentan, a relatively new treatment that widens the lung arteries and
reduces blood pressure;
nitric oxide inhalation, which causes the pulmonary arteries to widen or
open;
Viagra (sildenafil) which causes the pulmonary arteries to open; and
diuretics which may help ease symptoms and improve the heart's performance
in some patients with pulmonary hypertension.
The term "pulmonary hypertension" is composed of "pulmonary" for lung,
"hyper" for high, and "tension" for blood pressure = pulmonary high blood
pressure, or pulmonary hypertension.
The human body has two major sets of blood vessels that distribute blood from
the heart to the body. One set pumps blood from the right heart to the
lungs and
the other from the left heart to the rest of the body.
The portion of the circulation that
distributes oxygen-rich blood from the left side of the heart, throughout the
body, is referred to as the systemic circulation.
The blood then returns from
the body to the right side of the heart and passes through the lungs to
replenish oxygen.
It then returns to the left
side of the heart for another round through the systemic circulation.
The
portion of the circulation that distributes the blood from the right side of the
heart to the lungs is referred to as the pulmonary (lung) circulation.
The
pulmonary arteries are the major blood vessels that carry blood from the right
side of the heart to the lungs.
The left ventricle of the heart pumps oxygenated blood
(blood that has been reloaded with oxygen in the lungs) from the lungs into the
systemic circulation. When a doctor or a nurse measures the blood pressure on a
person's arm, he/she is measuring the pressures in the systemic circulation.
When these pressures are abnormally high, the person is diagnosed as having
high
blood pressure
(hypertension).
What is pulmonary hypertension?
The right ventricle pumps blood returning from the body into the pulmonary arteries to
the lungs to receive oxygen. The pressures in the lung arteries (pulmonary
arteries) are normally significantly lower than the pressures in the systemic
circulation. When pressure in the pulmonary circulation becomes abnormally
elevated, it is referred to as pulmonary hypertension, pulmonary artery
hypertension, or PAH.
Pulmonary hypertension results from
constriction, or stiffening, of the pulmonary arteries that supply blood to the
lungs. Consequently, it becomes more difficult for the heart to pump blood
forward through the lungs. This stress on the heart leads to enlargement of the right heart and eventually fluid
can build up in the liver and other tissues, such as the in the legs.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
A ventricular septal defect (VSD) is a congenital heart malformation. A VSD is a hole in the wall of the heart's two lower chambers. Approximately, one in 500 infants will be born with a VSD. Treatment depends upon whether the VSD is small or large in size.
Schistosomiasis (snail fever), a disease caused by parasites, causes a variety of symptoms and signs, such as cough, rash and bloody diarrhea. Praziquantel is used in the treatment of schistosomiasis.
The lungs are a pair of organs in the chest that are primarily responsible
for the exchange of oxygen and carbon dioxide between the air we breathe and the
blood.
The lung is composed of clusters of small air sacs (alveoli) divided by thin,
elastic walls or membranes. Capillaries, the tiniest of blood vessels, run
within these walls between the alveoli and allow blood and air to come near each other. The distance between the air in the lungs and the blood in the
capillaries is very small, and allows molecules of oxygen and carbon dioxide to
transfer across the membranes.
Air reaches the alveoli via the bronchial tree. The trachea splits into the
right and left mainstem bronchi, which branch further into bronchioles and
finally ends in the alveolar air sacs.
When we breathe in, air enters the lung and the alveoli expand. Oxygen is
transferred onto