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.
There are many causes of pulmonary hypertension. Often more than one
mechanism is involved in a specific disease process. This can also change as the
Diseases that effect flow out of the heart to the rest of the body result
in backflow of blood (stacking of blood) that raises pulmonary venous pressures
leading to pulmonary hypertension.
Hypoxic pulmonary vasoconstriction is the process in which the lung vessels
narrow in attempt to divert blood from poorly functioning segments of the lung.
For instance, when pneumonia develops, a portion of lung becomes inflamed and
works poorly in performing the functions of the lung (to add oxygen and remove
carbon dioxide from the blood). This process diverts blood from these poorly
working areas and sends it to better functioning lung tissue. However, a problem
develops when all the blood has a low oxygen level (hypoxia). This causes
constriction of the vessels on the pulmonary arterial side and hence raises the
Remodeling of blood vessels also occurs in some diseases whereby the inner
lining (lumen) of the vessel becomes narrowed due to inappropriate growth of the
tissue within and around the vessel. Masses and scarring from other diseases can
compress and narrow vessels causing increased resistance to flow resulting in
elevation of pressures.
In a fairly common parasitic infection in the Middle East
(schistosomiasis), the blood vessels in the lung become blocked by the parasites
causing pulmonary artery hypertension.
Some substances cause constriction of the blood vessels. Pulmonary
hypertension has been rarely reported with the use of anti-obesity drugs, such
as dexfenfluramine (Redux) and Fen/Phen. These medications have seen been
removed from the market. Some street drugs such as, cocaine and methamphetamines
can cause severe pulmonary hypertension.
Some diseases raise pulmonary pressures to cause pulmonary artery
hypertension for unclear
reasons. Perhaps an unknown toxin or chemical effects the blood vessels by
causes constriction or inappropriate growth of the tissue within or around the
vessel. For example, there is a condition known as portopulmonary hypertension
that is result of liver failure. When these individuals receive a liver
transplant, the pulmonary hypertension disappears suggesting that the failing
liver is unable to clear some biochemical that leads to pulmonary artery
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 11/25/2013