Pulmonary Hypertension Expert Forum
Value to testing venous blood gases during SOB
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Pulmonary hypertension is a condition associated with high blood pressure in the arteries that connect your heart with your lungs. It is a serious condition for which there are many emerging treatments but no definite cure. In this disease, the blood vessels that carry oxygen-poor blood from your heart to your lungs become hard and narrow, which causes your heart to work harder to pump the blood. This forum is a place to ask questions about Pulmonary Hypertension. Some examples are: What caused me to get pulmonary hypertension? How is pulmonary hypertension diagnosed? What treatment options are available?

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Value to testing venous blood gases during SOB

I have severe cardiac microvascular endothelial dysfunction. I am frequently SOB with minimal exertion. I understand that the dysfunctional blood flow from my cardiac micro vessels out and into circulation results in SOB. All PFTs have shown no evidence of lung issues.
My main cardiac drugs are Cardizem ED 120mg 2x day for vasospasm, Bystolic 5 mg 1 x day which relieves edema ( and helps vasodilation), nitro patches 0.18  ( three 0.6mg patches) during the day and reducing down nitro to one 0.4mg patch for nighttime coverage and recovery of enyzmes to handle nitro. I have been on this regime since 2008.I manage this cardiac dysfunction well. I am otherwise healthy but have signs of diastolic dysfunction and a developing floppy mitral valve as I am 68. I have OSA corrected with CPAP without O2 supplement. I had over 800 hypoxic or near hypoxic events in 8 hours prior to CPAP. I am not hypertensive or have pulmonary hypertension and would like to keep it that way!
QUESTION: When I have a very bad angina episode with severe SOB, my O2 SATS are always above low 90s or in high 90s. My BP increases to very high readings and I am tachy. I do not use supplemental O2 and even application of nasal cannula low dose 02 in an inpatient setting does not help and does not improve the SOB. Only using high dose IV nitro helps with that SOB and chest pain.
I have been asked by a medical person with the same problem with cardiac microangiopathy, why my venous blood is not checked before administering nitro and O2. The reasoning given by this person is that the VBG value is a better determination of oxygen need. She reports normal O2 SATs but abnormal VBG and she has to wait for that VBG before they start O2 and Nitro. I don't understand this testing and know that the most important thing in an angina crisis is to open up the heart's circulation and get that blood flowing regardless of immediate status of venous blood gas O2 content.
Thanks you for your answer. Joan.
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Jonathan D. Rich, MDBlank
Northwestern Memorial Hospital
Chicago, IL
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