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 Pulmonary Hypertension

 
According to Ada County Dispatch, a 77 yr. old male was found to be unresponsive at his residence by his wife after she returned from the grocery store.  EMS responded and found him to be PEA (pulseless electrical activity) but did administer CPR and several rounds of ALS (advanced life support) medications before finally calling the code and contacted this office to respond.
 
An Ada County Coroner Deputy responded to the residence.  After examining the body, he contacted the subject's doctor to obtain medical records.  During the conversation with the doctor, the deputy discovered that the subject had earlier in the day went to his doctor's office for a check-up and was told to go to the hospital for evaluation.  He refused to go to the hospital and went home.  The doctor stated that the subject had a history of severe Pulmonary Hypertension and COPD (Chronic Obstructive Pulmonary Disease) - was on two inhalers and several steroid medications.
 
According to the subject's wife, she had asked him what the doctor had said and he told her that "everything was fine".  She stated that he went into the living room and turned on the TV and she went to the store to pick up some items for dinner.  She said that he seemed fine except for the cough and congestion - the reason he had gone to see the doctor.
 
The subject's doctor stated that he would sign the death certificate with cause of death being: Pulmonary Hypertension and COPD with Natural being the manner of death.  The body was released from the residence to the family choice funeral home.
 
What is pulmonary hypertension?
 
Pulmonary hypertension (PH or PHT) is an increase in blood pressure in the pulmonary artery , pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. Pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and heart failure. It was first identified by Dr. Ernst von Romberg in 1891. According to the most recent classification, it can be one of five different types: arterial, venous, hypoxic, thromboembolic or miscellaneous.
 
Because symptoms may develop very gradually, patients may delay seeing a physician for years. Common symptoms are shortness of breath, fatigue, non-productive cough, angina pectoris, fainting or syncope, peripheral edema (swelling around the ankles and feet), and rarely hemoptysis (coughing up blood).
 
Pulmonary venous hypertension typically presents with shortness of breath while lying flat or sleeping (orthopnea or paroxysmal nocturnal dyspnea), while pulmonary arterial hypertension (PAH) typically does not.
 
A detailed family history is established to determine whether the disease might be familial. A history of exposure to drugs such as cocaine, methamphetamine, alcohol leading to cirrhosis, and tobacco leading to emphysema are considered significant. A physical examination is performed to look for typical signs of pulmonary hypertension, including a loud S2 (pulmonic valve closure sound), (para)sternal heave, jugular venous distension, pedal edema, ascites, hepatojugular reflux, clubbing etc. Evidence of tricuspid insufficiency is also sought and, if present, is consistent with the presence of pulmonary hypertension.

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