Angie Allgood was at Clemson Memorial Stadium in April to watch the Savannah Bananas baseball team when she decided to walk up the steps to get a snack. It changed the course of her life.
“I was a normal, healthy 51-year-old with a wonderful, boring medical history,” she said. “For about a year prior to April, I had been noticing some shortness of breath when I went up steps and just some changes in my ability to breathe. I also had started having some heart palpitations, but I completely pushed it all under the rug, thinking, I'm probably premenopausal. It's probably hormone changes… I just need to get on the treadmill more, right?”
“All of the symptoms that I now know were probably important to pay attention to, I completely pushed those away.”
As she walked up the steps, Allgood started having extreme difficulty breathing — and she didn’t have her phone. Her heart was racing and she collapsed, caught by a stranger standing behind her. When she regained consciousness, she was told that her skin had turned gray and her lips were purple. The people around her thought she had died.
After a battery of tests, Allgood was referred to Dr. Abhijit Raval, a pulmonary and critical care specialist at AnMed Pulmonary and Sleep Medicine, who discovered that she has pulmonary arterial hypertension, often referred to as PAH, a form of pulmonary hypertension.
AnMed was South Carolina’s first accredited regional care center and the nation’s sixth, offering leading-edge care and treatment of the condition.
Understanding Pulmonary Hypertension
Pulmonary hypertension, or PH, is a complex disease that can be caused by a variety of factors. According to the Pulmonary Hypertension Association, which marks November as Pulmonary Hypertension Awareness Month, PH is a progressive lung condition in which patients experience high blood pressure in their lungs. Arteries in the lungs can become damaged, narrowed or stiff, putting pressure on the right side of the heart and forcing it to work harder to push blood through the arteries. This can cause right heart failure and death.
“It used to be considered as a female, young age predominant disease, but that's not true anymore,” Dr. Raval said. “The diagnosis is complicated. Most of the time, people have shortness of breath with exertion, and then as it progresses, they may have more symptoms, like chest pain, swelling in the feet, passing out spells, which are rather delayed symptoms.”
The vague symptom of shortness of breath during exercise makes it difficult to pin down and often delays diagnosis.
“It requires testing from all different standpoints. It needs several blood tests checking for metabolic issues and liver problems,” Dr. Raval said.
Tests may be needed to check for lung or heart abnormalities, blood clots, sleep apnea, autoimmune disorders and more — all of which could be more common causes of shortness of breath. The “gold standard” test is a right heart catheterization.
“It is a small catheter, a plastic tube, that we introduce through a vein, and then it goes through different chambers of the patient's heart,” Dr. Raval said. “That is the test that will distinguish between whether it is the pulmonary arterial hypertension, which is pretty rare, versus pulmonary hypertension, which is more common.”
“PH is generally associated with underlying diseases, including heart failure, valvular heart disease, sleep apnea, lung disease, COPD lung disease associated with scarring, post-COVID, and pulmonary fibrosis. For people that develop pulmonary fibrosis, we do have a very specialized inhaler treatment available for that, which is quite new. Other than that, we take care of these folks with rehab, diet modification, fluid medication, sleep apnea treatment, exercise therapy and so on. We treat the underlying problem that is contributing to elevation of pressure within the pulmonary system.”
A Second Chance for the Future
Most people see more than two physicians to get a diagnosis.
“People are sent from a lung specialist to a heart specialist by their internal medicine doctors and maybe from one center to another center before someone thinks about pulmonary hypertension,” Dr. Raval said.
With PAH, which is the form Allgood has, about half of the cases are idiopathic, which means there is no known underlying cause. Many cases are associated with autoimmune conditions including lupus and scleroderma. But Allgood noted that her great-grandfather, grandfather and father all died suddenly at young ages, and family history is a risk factor for PAH.
“I am kind of grateful that, if this is genetic, for whatever reason, I was able to wake up from what my dad and my grandfathers never woke up from,” she said.
Dr. Raval is treating Allgood with specialized medication. AnMed offers a disease-specific coordinator to help PH and PAH patients navigate their care, as well as a support group and participation in research programs in conjunction with other centers including Duke University Medical Center and the Medical University of South Carolina.
But Dr. Raval said one of the most important roles filled by the center is working with local health care providers to help patients get a diagnosis — then they can get appropriate treatment and ongoing care and evaluation.
It’s working for Allgood. Six months after she collapsed at the game, she was able to see the Savannah Bananas again, and this time, she saw every at-bat.
“I got to sit and enjoy the entire game,” she said. “It was wonderful.”
