Phen-Fen Causes Pulmonary Hypertension

Case Overview

This case involves a patient who developed pulmonary hypertension after using the drug Fenfluramine/phentermine for a one year period. The patient experienced chest pain and severe shortness of breath and was subsequently admitted to the hospital for a workup to rule out thromboembolic disease as a potential cause. The original CT-angiogram was read as having a low index of suspicion for thromboembolic disease. A short time after the patient underwent a perfusion scan and a pulmonary angiogram that revealed chronic embolic disease.

Questions to the Critical Care Medicine expert and their responses

Can you determine from chest imaging whether it is likely that the patient had pulmonary hypertension at the time the embolism was diagnosed?

A CT angio is good at picking up an acute PE, but chronic disease is best picked up on a V/Q or angiogram. Enlargement of the pulmonary vessels on CT could be suggestive, but not diagnostic of pulmonary hypertension.

If so how does pulmonary hypertension increase the risk of thromboembolic disease?

Chronic thromboembolic disease causes pulmonary hypertension. Pulmonary hypertension can worsen thromboembolic disease, in my opinion, mostly indirectly.

About the expert

This actively practicing, board-certified pulmonologist specializes in infectious lung diseases and is the director of the infectious lung disease program at a major medical university. He also holds a M.S. in human physiology from a among the nation's top academic institutions, and is actively involved in clinical pharmaceutical research in his field.