Brief Answer:
I think there is need for diagnostic evaluation

Detailed Answer:
Hello,
Thanks for using healthcaremagic.

I read your query with interest and found that there is more need to be done before making diagnostic conclusion. I agree that in many cases only damage is seen in most of the investigations but lot can be suspected on basis of history alone.

The most significant thing that is against Pulmonary hypertension in you is short duration of illness. I like to inform you that patients who have pulmonary hypertension present with illness duration in years. There is some evidence of pulmonary function derangement before debilitating illness. In contrast to classical presentation you had just month of history before getting bad ridden for 14 hours a day. This kind of presentation i most likely of infective cause which resolves in two to four weeks without intervention in majority of cases.

I do not recommend cialis or viagra at this stage before looking at your reports.
Kindly send your all available reports and get an appointment for polysomnography or sleep study.
I look forward to see you with reports. Please feel free to write any relevant details in follow up query. I will be glad to assist you.
Thanks and regards
Dr Ashok Kumar

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Brief Answer:
This can be explained

Detailed Answer:
Hello,
Welcome back to healthcaremagic.

I am not denying that you are not having pulmonary arterial hypertension but I am just trying to emphasize that there is no concrete evidence for same at this day. Symptoms of fatigue can present in pulmonary hypertension but before that there are thousand conditions which need consideration.

I agree that it should be identified in early stage but it is not recommended to start treatment with potential side effects without proper diagnosis. Antibiotics do not work in most of the viral pathology and that should not make you to believe that this is pulmonary hypertension.

As your doctor mentioned sleep apnea, a sleep disorder can present with fatigue and getting up with trying to catch breath. Presence of sinus congestion is one of the risk factors for snoring during sleep and difficulty in breathing.

It is possible that since you started treatment with vigra (phospho di esterase inhibitor) there was relaxation of smooth muscle in your airway resulting in the improvement. Other than smooth muscle effect viagra too have psychological benefit for a person with erectile dysfunction resulting in low anxiety and sense of well being and improved exercise performance.

To conclude in my view what ever you take, take with proper guidance and utmost care. Viagra and cialis have their own side effects and this may be counter productive for you once you start taking it without any proper indication. As I said earlier please get your polysomnography done as earliest so inconvenience can be avoided and the underlying cause can be treated in proper manner.

Thanks and regards
Dr Ashok Kumar

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Brief Answer:
I do not think it is pulmonary hypertension

Detailed Answer:
Hello,
Welcome back.

I agree with everything that there was no abnormality. I also agree that they are used to detect damage but please note if there is pulmonary hypertension a loud P2 or hyperkinetic sound of second valve closure can be detected even before any damage with echo cardiogram. And fortunately that came out normal. Chest X ray do not detect much in early stage but scan and echo have tremendous usefullness in diagnosis of pulmonary hypertension even in the early stage.

Agreeing or not agreeing depends on you but what is possible with available evidence I am trying to make rational decision. If you have more questions you can call me directly at my XXXXXXX number 0000 for better understanding of the problem.

Thanks and regards
Dr Ashok Kumar

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Brief Answer:
Please Go through standard textbook

Detailed Answer:
Dear XXXXXXX
Thanks again for using HCM.

As I said earlier pulmonary hypertension is neither ruled out nor confirmed in your case.
I request you to provide symptom details other than already mentioned difficulty in catching breath and fatiguebality so a clinical possibility can be considered.

I agree with your echo finding but that is true in minority of patients. I request you to go through XXXXXXX Textbook of Internal Medicine for better understanding of the problem. What you get over internet is not evidence based and there is no check or error correcting mechanism. If you want to know the latest knoledge it is advisable to go through mentioned textbook.

This is short textbook and for a non medical person sufficient to know. In case you need to know more please write back to me. I will provide the latest available evidence with proper explanation of each and every component.
Thanks and regards
Dr Ashok

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Brief Answer:
I am noting down below from textbook

Detailed Answer:
Dear XXXXXXX
Welcome again.

I am just copying the diagnostic evaluation from the standard textbook of pulmonary medicine. Please read it and let me know if there is any doubt after going through this.
As I said earlier lot need to be done before jumping to conclusion and making a diagnosis of pulmonary hypertension.

" Diagnostic testing is used to confirm the presence of pulmonary hypertension, identify the etiology, assess severity and prognosis, and help to identify appropriate therapy.
When pulmonary hypertension is suspected, the echocardiogram is the appropriate first test.Indeed, as noted, evidence of pulmonary hypertension on an echocardiogram is often what first brings the issue to attention. A carefully performed Doppler examination is able to quantify the tricuspid regurgitant jet in themajority of cases. A modified bernoulli equation is used to estimate the right ventricular systolic pressure (RVSP=4v2+right atrial pressure; where v =tricuspid jet velocity in meters per second)and is assumed to equal the pulmonary artery systolic pressure when the pulmonic valve is normal.Normal RVSP has been reported as 28 ± 5 mmHg. Echocardiographic evaluations during exercise
are an additional consideration when estimates of RVSP at rest are normal and suspicion of pulmonary hypertension is high (e.g., dyspnea in a patient with no obvious cause). Echocardiographic measurements taken at peak exercise may reveal inordinate increases in pulmonary arterial pressures, perhaps signaling the presence of earlier disease. Normative echocardiographic values of RVSP
during exercise have not been well established.
The echocardiogram can also reveal important information about cardiac structure and function. It enables evaluation for a patent foramen ovale and intracardiac or intrapulmonary shunting of blood (e.g., using a bubble contrast).
Echocardiography can also help to rule out related anatomic abnormalities, such as acquired or congenital mitral valve disease or a left atrial myxoma. Left ventricular hypertrophy, diastolic noncompliance, decreased systolic function, or focal
hypokinesis as well as mitral or aortic valvular defects are essential observations when evaluating the likely cause of pulmonary hypertension. Dilation and decreased function of the right ventricle are indications of the functional importance and severity of pulmonary hypertension. Taken together, an
evaluation of right ventricular contraction, relaxation, and ejection can yield functional information with prognostic value in patients with PH. The presence and size of a pericardial effusion are poor prognostic signs. Flattening
of the interventricular septum occurs with advanced dilation and failure of the right heart, and the leftward movement of the septum may denote impairment of left ventricular filling.
While the correlation between echocardiographic estimates of PASP and measurements taken at right heart catheterization are generally good, it must be remembered that there is significant variability. Confirmation by cardiac
catheterization is required when the presence of pulmonary hypertension will influence the approach to treatment. For example, in the setting of some patients with severe COPD in whom an echocardiogram reveals evidence of pulmonary hypertension, confirmation by right heart catheterization might not influence medical therapy. If, on the other hand, surgical intervention for the COPD is a consideration (e.g., for lung transplantation or lung volume reduction), confirmation of the presence of pulmonary hypertension by cardiac catheterization
is important. When the diagnosis is thought to be pulmonary arterial hypertension, diagnostic catheterization confirms the diagnosis and is useful in guiding therapy.


Once evidence of pulmonary hypertension has been established by echocardiography, testing for possible causes is in order. Pulmonary function tests, a ventilation-perfusion scan and overnight oximetry are essential to screen for possible underlying obstructive or restrictive lung disease, occult
thromboembolism, and sleep-disordered breathing, respectively.
Blood tests including HIV antibody, rheumatologic serologies (e.g., ANA), liver function tests, and a complete blood count are essential. A plain chest radiograph (together with the pulmonary function tests) may suggest the presence
of parenchymal lung disease; in such patients further evaluation with CT is usually warranted. Early in the evolution of pulmonary hypertension, the chest radiograph appears normal. In time, the central pulmonary arteries become increasingly prominent as the peripheral vessels become attenuated, and the cardiac silhouette enlarges . An electrocardiogram should be obtained and may indicate signs of ischemic heart disease or conduction abnormalities. The electrocardiogram almost invariably shows some evidence of right ventricular overload, usually in conjunction with right atrial impairment .

Baseline testing should also include assessments of exercise tolerance and whether supplemental oxygen is required. A 6-minute walk test is a useful means of assessing exercise capacity and prognosis, and serial testing can be useful in
evaluating the response to therapy. Measurements of arterial oxyhemoglobin saturation both at rest and during exercise are important to be sure that adequate oxygenation is maintained and, if not, to titrate with supplemental oxygen
accordingly.
Cardiac catheterization is required in most cases to confirm the diagnosis of pulmonary hypertension, test for important cardiac causes and, in appropriate patients, perform vasodilator trials to determine therapy. E

In addition to coronary angiography, measurement of the LVEDP is important to exclude left atrial hypertension (e.g., as seen in diastolic dysfunction) as an important cause of pulmonary hypertension. Direct measurement may be required
in the presence of severe pulmonary hypertension when an adequate estimate of LVEDP cannot be obtained using a wedged pulmonary artery catheter. Right heart catheterization, using a balloon-tipped flow-directed pulmonary artery
catheter, is performed to confirm the presence of pulmonary hypertension. Attention also should be paid to the level of right atrial pressure since significant
increase worsens the prognosis.As noted, pulmonary hypertension is defined as a mean pulmonary resting artery pressure greater than 25 mmHg. When pulmonary arterial pressure is normal at rest, measurement during exercise may
be performed using serial leg lifts, arm raising with weights, pulmonale
on the electrocardiogram.

I hope this will clear your doubt. If anything else you need to know I will provide the required details.
Thanks and regards

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Brief Answer:
And what about the differential diagnosis

Detailed Answer:
Hello,
Thanks again.

I agree with few of the points but it is not true for echo cardiography.
Having said this you need to rule out ample number of conditions to make a diagnosis of pulmonary hypertension. The symptom you are having can be present in following conditions and with appropriate clinical history and diagnostic tests a proper diagnosis can be made.
The differential diagnosis of PH are

1. Apnea, Sleep
2. Cardiomyopathy, Dilated
3. Hypothyroidism
4. Stenosis
5. Mixed Connective-Tissue Disease
6. Portal Hypertension
7. Pulmonary Hypertension, Secondary
8. Pulmonic Stenosis
9. Scleroderma
10. Systemic Lupus Erythematosus

I hope after going through these things you understand the complex process of making a diagnosis and consequences of wrong diagnosis.

I Have explained my point of view and because of certain limitations of online query posting and answering everything can not be explained in written form as lot of investigations are pending and there is no concrete evidence for concerned diagnosis at this point of time.

I request you to check with your treating doctor for further investigations to confirm or refute the diagnosis.
Thanks and regards'
Dr Ashok

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