Imagine you’re caring for a patient who’s been short of breath for months. Their echocardiogram shows right heart strain, but they’re young, with no obvious cardiac disease. You’re thinking: What am I missing?

In today’s episode, we’re taking a closer look at pulmonary hypertension—a condition that’s often misdiagnosed or missed entirely until it’s advanced. It can mimic more common conditions like asthma or heart failure, but its management requires a very specific and nuanced approach.

To guide us through it, I’m joined by Emily Fedewa, nurse practitioner with the Pulmonary Hypertension Program at UCSF Health. Emily is part of a multidisciplinary team that cares for some of the most complex pulmonary hypertension patients on the West Coast. Together, we’ll explore pathophysiology, clinical presentation, diagnostic workup, and current therapeutic options—including emerging treatments and the critical role of nurse practitioners in chronic disease management.

If you’ve ever felt stumped by unexplained dyspnea or struggled to understand how pulmonary hypertension differs from other cardiopulmonary conditions, this one’s for you.

Whether you’re in cardiology, pulmonary medicine, or primary care, this episode will give you practical insights into one of medicine’s more challenging diagnoses.

Emily Fedewa, MSN, APRN, FNP-BC: UCSF Health Profile

2:14-Levels of Nursing and Education Video

Levels of Nursing Practice

2:40-Interventional Cardiology at UCSF Health

2:43- CCU or Cardiac Care Unit

6:17-Assessing fluid volume status: euvolemia/hypervolemia/hypovolemia

7:10-Medicare Telehealth

Telehealth includes medical or health services that you get from your health care provider who’s located somewhere else (in the U.S.) using audio and video communications technology (or audio-only services in some cases), like through your phone or a computer. Telehealth can provide many services that generally occur in-person, including office visits, psychotherapy, consultations, and certain other medical or health services.

Through September 30, 2025, you can get telehealth services at any location in the U.S., including your home. Starting October 1, 2025, you must be in an office or medical facility located in a rural area (in the U.S.) for most telehealth services. If you aren’t in a rural health care setting, you can still get certain Medicare telehealth services on or after October 1, including:

* Monthly End-Stage Renal Disease (ESRD) visits for home dialysis

* Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit

* Services for the diagnosis, evaluation, or treatment of a mental and/or behavioral health disorder (including a substance use disorder) in your home

From https://www.medicare.gov/coverage/telehealth

https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

8:24-

8:47- Pulmonary Hypertension at UCSF Health

9:00-Circulation

9:50-Cardiac Afterload

9:24-Right ventricle

9:49-WHO groups

https://phassociation.org/types-pulmonary-hypertension-groups/

10:25-Portal hypertension

10:40- HFpEF

Types of Heart Failure

11:16- CTEPH

11:44- Sarcoidosis

11:48-Sickle Cell Disease

13:27- Risk Factors

13:40- Scleroderma

13:59- Interstitial Lung Disease (ILD)

14:17- PHTN symptoms

15:40-Heart Failure symptoms

19:30- Right heart catheterization (RHC)

19:58- Wedge pressure

2016- Output

2027- Etiology- the cause

20:31- Pre and post capillary

22:50-Coronary Artery Disease

23:12-Left heart catheterization (LHC)

23:59- Treatment

41:13- Lifestyle factors

46:52- Pulmonary Hypertension Association

47:49-

49:45- Safety, Feasibility, and Utility of Digital Mobile Six-Minute Walk Testing in Pulmonary Arterial Hypertension: The DynAMITE Study.

Produced by Nadja Wlasiuk, NP

Get full access to In the Loop with Nadja Wlasiuk at intheloopwithnadja.substack.com/subscribe