The predominant cause of pulmonary hypertension is alveolar hypoxia secondary to lung disease, impaired control of breathing, or residence at high altitude. Monitor for the presence of pulmonary hypertension in patients with mixed obstructive and restrictive patterns of lung disease, COPD, emphysema, chronic bronchiectasis, pulmonary fibrosis, and cystic fibrosis.—Tracy Fasolino, PhD, FNP, Salem, S.C. (204-3)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.

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