November is Pulmonary Hypertension Awareness Month. Pulmonary hypertension is high pressure in your pulmonary arteries, the blood vessels that carry blood from your heart to your lungs. Oxygen-poor blood returns to the right side of your heart. The lower chamber — the right ventricle — pumps the blood into the pulmonary arteries and into the lungs to be enriched with oxygen. Your heart then pumps the oxygen-rich blood to your body’s organs and tissues.

When your pulmonary pressure is consistently high, the arteries in your lungs can narrow, and your heart must work harder to pump blood into the lungs. Over time, this extra work weakens your heart and you can develop heart failure, a condition in which your heart can no longer pump enough oxygen-rich blood for your body’s daily needs.

Many things can cause pulmonary hypertension. These include certain congenital heart defects; connective tissue disease; coronary artery disease; liver disease, such as cirrhosis; hypertension (high blood pressure); blood clots in the pulmonary arteries; HIV; pulmonary fibrosis (a condition causing scarring in the lungs); chronic lung disease, such as emphysema; heart failure; and genetics.

Pulmonary hypertension may not cause any signs or symptoms at first. In many cases, shortness of breath or lightheadedness during activity is the first symptom. As the condition progresses, signs and symptoms may become more noticeable and may include:

• Increased shortness of breath, first with activity and eventually even at rest.
• Bluish lips and skin.
• Dizziness or fainting.
• Fatigue.
• Decreased appetite.
• Chest pain or pressure.
• Palpitations (rapid, pounding heartbeats).
• Swelling of the ankles, legs and belly.

The early signs and symptoms, such as shortness of breath and fatigue, are common to many other medical conditions. Therefore, diagnosis is often delayed until more serious symptoms develop.

Because pulmonary hypertension may be caused by many medical conditions, your doctor will perform a thorough medical history and physical exam, including a detailed discussion of your symptoms. This helps the doctor rule out other disorders.

Your doctor may order certain tests to aid in the diagnosis. These include blood tests; lung function tests; and imaging exams, such as a chest x-ray, CT or MRI, to get a closer look at your lungs and right ventricle. The doctor may recommend an echocardiogram, which uses sound waves to create moving pictures of your beating heart. This shows blood flow through your heart. A right heart catheterization can confirm the diagnosis of pulmonary hypertension.

There is no cure for pulmonary hypertension, but treatment is available to help improve signs and symptoms and slow the progression of the disorder. The treatment you receive will depend, in part, on the cause of your condition and will focus on treating the cause. However, certain treatments are generally used no matter what the cause.

Medications such as diuretics, or water pills, reduce fluid buildup in your body. Anticoagulants, or blood thinners, help prevent blood clots from forming or growing larger. Inotropic agents improve the heart’s pumping ability. Vasodilators relax and open narrowed blood vessels and improve blood flow. A drug called digoxin helps your heart beat stronger and pump more blood. Your doctor may recommend therapy to raise the level of oxygen in your blood.

If medications don’t control your signs and symptoms, your doctor may recommend surgery. Surgical procedures includes atrial septostomy, an open-heart surgery in which the surgeon creates an opening between the upper left and right chambers of the heart (atria) to ease the pressure on the right side of the heart.

A lung or heart-lung transplant may be recommended in severe cases that don’t respond to any treatments. In these cases, your lungs or your heart and lungs are removed and replaced with healthy organs from a donor.

Certain lifestyle changes can also help improve your life with pulmonary hypertension. Consider making these changes:

• Quit smoking.
• Eat a healthy diet. Include a variety of fruits, vegetables, whole grains and lean protein. Ask your doctor if you need to limit anything in your diet, such as salt or vitamin K. Vitamin K, for instance, can affect how well blood-thinning medications work.
• Be physically active. Incorporate regular activity such as walking into your daily routine. Ask your doctor if there are any activities, such as lifting heavy objects, you should avoid.
• Seek emotional support. Living with a serious, chronic disorder such as pulmonary hypertension can cause emotional issues, such as anxiety and depression. Tell your doctor how you feel. He or she can direct you to the appropriate resources (counseling, medication, patient support group).

Patti DiPanfilo