What Is the Most Appropriate Treatment for Pulmonary Hypertension?

Pulmonary hypertension is a medical term for a condition where high blood pressure affects the right side of your heart and the arteries in your lungs.

If these arteries and veins turn stiffer and narrower, the blood flow to the lungs becomes slower. Hence, your heart needs to pump blood with greater force. This effort weakens the cardiac muscles, which may cause the heart muscles to weaken and fail.

The body does not receive an adequate amount of oxygen supply as your lungs become incapable of supplying enough oxygen due to this condition.

However, there are several treatment procedures now available for patients suffering from pulmonary hypertension. Thus, you can expect to reduce the intensity of symptoms by following what your doctor recommends.

What are the major causes of pulmonary hypertension?

Depending on its cause, pulmonary hypertension is categorized into 5 groups.

Group 1:

Pulmonary Arterial Hypertension (PAH)

Causes include:

• Idiopathic PAH (Unknown cause)
• Hereditary PAH
• Congenital Heart Disease
• Use of some prescription diet medicines or illegal drugs like meth
• HIV infection, cirrhosis (chronic liver disease) and connective tissue disorders

Group 2:

Pulmonary Hypertension due to left-sided heart disease

Causes include:

• Left-sided heart valve disease like aortic valve or mitral valve disease
• Failure of the lower left heart chamber

Group 3:

Pulmonary hypertension due to lung disease

Causes include:

• Pulmonary fibrosis
• Long-term exposure to high altitudes
• Chronic obstructive pulmonary disease (COPD)
• Obstructive sleep apnea

Group 4:

Pulmonary hypertension due to chronic blood clots

Causes include:

• Chronic blood clots in the lungs
• Other clotting disorders

Group 5:

Pulmonary hypertension triggered by other health conditions

Causes include:

• Blood disorders like essential thrombocythemia and polycythemia vera
• Inflammatory disorders like sarcoidosis and vasculitis
• Metabolic disorders, including glycogen storage disease
• Kidney disease
• Tumors pressing against pulmonary arteries

What are the symptoms of pulmonary hypertension?

You may not feel ANY symptoms of pulmonary hypertension at the initial stage of the medical condition. Hence, it is difficult to diagnose it for several months unless the symptoms become prominent. Some main symptoms of this ailment are as follows:

• Shortness of breath while working or resting.
• Tiredness or lack of energy.
• Chest palpitations or pain.
• Feeling dizzy that may result in fainting.
• Abnormal swelling of ankles and legs that gradually spreads to the abdomen.
• A rapid increase in heartbeat and pulse rate.
• Pale bluish tint on the lips and facial skin.

When to see a doctor?

If you have the above mentioned symptoms , you should definitely see a doctor. You will be examined medically, history taken , and you might have to undergo some tests, after which the doctor will begin with your treatment.

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What are the diagnostic procedures to detect pulmonary hypertension?

Your doctor will recommend a few diagnostic tests before confirming the presence of pulmonary hypertension.

• Chest X-ray
• An electrocardiogram or ECG checks the condition of your heart. An unusual enlargement or strain on the heart’s right chambers can be a sign of hypertension in the lungs.
• An echocardiogram
• An exercise test . The doctor will attach a monitoring machine to your body to read your blood pressure, normal oxygen level in human body, and other parameters during this brief exercise session.
• CT scan of the lungs helps to detect lung problems, which may obstruct breathing.
• Ventilation-perfusion scan is one more diagnostic test to locate blood clots present in the pulmonary blood vessels.
• Computerized tomography (CT): This test can be used to look more closely for any lung disease that may lead to pulmonary hypertension like pulmonary fibrosis or COPD. A contrast material (dye) can be injected into the blood vessel before a CT scan to help arteries show up more clearly on the images.
• Lung (pulmonary) function test: Lung function test is a non-invasive test that measures the airflow in and out of the lungs and how much air the lungs can hold.
• Magnetic resonance imaging (MRI): A physician may order MRI test to check the blood flow in the pulmonary arteries and understand how well the right ventricle is working.
• Sleep study (polysomnogram)
• Blood tests can also check the presence of other diseases in the body, like rheumatic arthritis or HIV
• Right heart catheterization is the test where the doctor inserts a catheter into a vein. Usually, the doctor chooses the larger veins of your femoral region or neck for this test. This catheter passes to the right chambers of your heart and reads the pressure in the heart and pulmonary arteries
• Vasoreactivity test, wherein the doctor loads the catheter with certain medicines to check lung-related blood vessel stiffness

What are the risk factors that may worsen pulmonary hypertension?

• Age: Age is a vital risk factor for this ailment. Typically, people between the age of 30 and 60 face a higher risk. Older patients suffering from this ailment may ideally experience more complications.
• Family history: If someone in the family is known to have suffered from pulmonary hypertension, it will likely be passed down to the younger generation.
• Higher altitude location: If you have been living in a higher altitude area for an extended period, you may gradually develop this disease.
• Obesity: Excessive body weight may also pose a higher risk
• Medication: Some medicines used for weight loss or the treatment of depression can have adverse effects.
• Drug-addiction
• Asbestos exposure: Prolonged asbestos exposure is another risk factor for this disease.

What are the complications associated with pulmonary hypertension?

Some of the complications that one can experience with pulmonary hypertension if not treated on time are as follows:

• Blood clots: There are chances that the small arteries of the lung could develop blood clots.
• Bleeding: If pulmonary hypertension is not treated, one could experience bleeding in the lungs and hemoptysis, which is coughing blood.
• Right-side heart failure or enlargement: The heart’s right ventricle could enlarge resulting in the failure of the right ventricle.
• Arrhythmia: Pulmonary hypertension may lead to a pounding heartbeat, irregular heartbeat, fainting, dizziness, and other issues

Pulmonary hypertension in pregnant women could be life-threatening to both the baby and the mother; hence it must be treated on time.

What are the clinical treatments for pulmonary hypertension?

The treatment for reducing pulmonary hypertension symptoms may vary from one patient to another based on the medical history of a person, cause  and their present physical condition. However, your doctor may prescribe different medications based on specific problems related to this ailment.

• Calcium channel blockers are medicines that help decrease blood pressure in your lungs and throughout your body. Such medicines can loosen the muscles on the walls of blood vessels.
• Vasodilators are medicines used for dilating blood vessels that have become narrower. Epoprostenol, Treprostinil, and Iloprost are vasodilators that your doctor may prescribe. The doctor may administer these medicines through intravenous injections. You can also take these drugs orally or inhale them through a nebulizer.
• Endothelin receptor antagonists are medicines that help slow down the harmful effects of endothelin, which is a specific peptide or amino acid chain formed in your body. This substance can be responsible for blocking arteries or veins.
• Guanylate cyclase stimulators help in boosting the amount of nitric oxide in your body. Nitric oxide is useful in relaxing the muscles of blood vessels. Thus, your overall blood pressure decreases to some extent. However, these medications have some adverse side effects and are not suitable during pregnancy.
• Warfarin is an effective anticoagulant or blood thinner medicine. Your doctor may recommend it if you have blood clots in your lung capillaries.
• Oxygen therapy is a treatment that provides pure oxygen for inhalation. Oxygen passes through prongs fitted to the nose of the patient. This treatment is advised if you climb to higher altitudes or if you have sleep apnea. Some patients in the late stage of pulmonary hypertension may need this therapy continuously for breathing.
• Diuretics are medicines that are used for helping kidneys in faster excretion. This reduces the risk of fluids accumulating in your lungs or other body parts. It makes the heart muscles work more efficiently.

Surgery is the last option recommended by a doctor if all other medicines fail to provide relief to a patient.

• Atrial septostomy may be recommended if medicines do not control the signs and symptoms pulmonary hypertension. In an atrial septostomy, a surgeon makes an opening between the upper left and the atria (right chambers of heart) to relieve pressure on the right side of heart. A transplantation of affected lungs may also be suggested .

What are the precautions to avoid pulmonary hypertension?

Some precautionary measures that can help you concerning pulmonary hypertension:

• You need to quit smoking, as it can worsen the condition of your lungs.
• You should not take any other medicine without consulting your doctor
• Living in high altitude regions may pose a risk .
• You should visit your doctor for regular checkups to live a healthy life.

Frequently Asked Questions

1. Can pulmonary hypertension be cured completely?

This medical condition can be cured once its cause is diagnosed and addressed by your doctor. If the cause cannot be treated soon, like in chronic lung disease, it may gradually turn fatal.

2. Which foods should you avoid if you are suffering from pulmonary hypertension?

You need to avoid coffee and alcoholic drinks, as that can cause high blood pressure. You should include iron-rich foods, like spinach and red meat, as well as Vitamin C-rich foods, like broccoli, orange, lemon, tomato, and bell pepper in your daily diet.

3. Is walking beneficial for patients suffering from pulmonary hypertension?

Brisk walking for at least 20-30 minutes helps keep your body active, which is essential for this medical condition. But, it is better to consult a doctor before starting any exercise regime.