Pulmonary hypertension (patient information)

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Overview
Pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs. It makes the right side of the heart need to work harder than normal.

What are the symptoms of Pulmonary hypertension?

 * Shortness of breath or light-headedness during activity is often the first symptom.


 * Fast heart rate (palpitations) may be present
 * Over time, symptoms occur with lighter activity or even while at rest
 * Other symptoms include:
 * Ankle and leg swelling
 * Bluish color of the lips or skin (cyanosis)
 * Chest pain or pressure, usually in the front of the chest
 * Dizziness or fainting spells
 * Fatigue
 * Weakness


 * People with pulmonary hypertension may report good days and bad days.

What causes Pulmonary hypertension?

 * The right side of the heart pumps blood through the lungs, where it can receive oxygen. When the small arteries (blood vessels) of the lung become narrowed, they cannot carry as much blood. When this happens, pressure builds up. This is called pulmonary hypertension. The heart needs to work harder to force the blood through the vessels against this pressure. Over time, the right side of the heart may become enlarged. At some point, not enough blood flows to the lungs to pick up oxygen and symptoms begin. At this point, heart failure that involves the right side of the heart is present. This is called cor pulmonale.


 * Pumonary hypertension may be caused by:
 * Any condition that causes chronic low oxygen levels in the blood
 * Autoimmune diseases that damage the lungs, such as scleroderma and rheumatoid arthritis
 * Certain birth defects of the heart
 * Certain diet medications
 * Congestive heart failure
 * History of a blood clot in the lung (pulmonary embolism)
 * HIV infection
 * Lung or heart valve disease
 * Obstructive sleep apnea


 * In many cases the cause is unknown, in which case the condition is known as idiopathic pulmonary arterial hypertension (IPAH). IPAH is rare. It affects more women than men.


 * If it is caused by a known medicine or medical condition, it is called secondary pulmonary hypertension.

When to seek urgent medical care?
Call your health care provider if:
 * You begin to develop shortness of breath when you are active
 * Shortness of breath worsens
 * You develop chest pain
 * You develop other symptoms

Diagnosis

 * A physical examination may show:
 * Abnormal heart sounds (especially a splitting of the second heart sound)
 * Enlargement of the veins in the neck
 * Feeling of a pulse over the breastbone
 * Heart murmur
 * Leg swelling
 * Liver and spleen swelling
 * Normal breathing sounds


 * In the early stages of the disease, the exam may be normal or almost normal. The condition may take several months to diagnose. Asthma causes similar symptoms and must be ruled out.


 * Tests may include:
 * ECG
 * Chest x-ray
 * Echocardiogram
 * CT scan of the chest
 * Nuclear lung scan
 * Cardiac catheterization
 * Pulmonary arteriogram
 * Pulmonary function tests
 * Sleep study

Treatment options

 * There is no known cure.
 * The goal of treatment is to control symptoms.
 * It is important to treat medical disorders that cause pulmonary hypertension, such as obstructive sleep apnea, lung conditions, and heart valve disorders.


 * Many new treatment options for idiopathic pulmonary arterial hypertension (IPAH) and other forms of pulmonary aterial hypertension are becoming available. Medicines used to treat pulmonary hypertension include:
 * Ambrisentan (Letairis)
 * Bosentan (Tracleer)
 * Calcium channel blockers
 * Diuretics
 * Prostacyclin or similar medications
 * Sildenafil


 * Your doctor will decide which medicine is best for you. You will be closely monitored during treatment to watch for side effects and to see how well you're responding to the medication. Never stop taking medicines without talking to your doctor.


 * Some patients are put on blood thinners to reduce the risk of blood clots in leg veins and lung arteries.


 * People with advanced cases of pulmonary arterial hypertension may need oxygen. If treatment with medications fails, suitable candidates may be helped by a lung or heart-lung transplant.


 * As the illness progresses, you will need to make changes in the home environment and get more help around the home.


 * Other important tips to follow:
 * Avoid pregnancy
 * Avoid strenuous activities and heavy lifting
 * Avoid traveling to high altitudes
 * Keep up to date with yearly flu and pneumococcal pneumonia vaccines
 * Stop smoking

Where to find medical care for Pulmonary hypertension?

 * Most patients with pulmonary arterial hypertension are treated at centers that specialize in the care of these patients.

Directions to Hospitals Treating Pulmonary hypertension

What to expect (Outlook/Prognosis)?

 * The long-term outlook has been poor, but new therapies may produce better results. Some people with this condition may develop progressive heart failure that may lead to death.


 * Avoiding pregnancy is recommended.

Possible complications

 * Right-sided heart failure (cor pulmonale).
 * Blood clots.
 * Arrhythmia (irregular heart beats).
 * Bleeding into the lungs and coughing up blood.