The Pressure On Heart And Lungs: Understanding The Silent Dangers Of Pulmonary Hypertension

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Pulmonary hypertension (PH) is high pressure in the pulmonary artery, the blood vessel that carries blood from the heart to your lungs. Oxygen-depleted blood returns to the right side of the heart. The lower chamber (right ventricle) pumps the blood into the pulmonary artery and into the lungs to be enriched with oxygen. The heart then pumps the oxygen-rich blood to organs and tissues. When pulmonary pressure is consistently high, the arteries in the lungs can narrow, and the heart must work harder to pump blood into the lungs. Over time, this extra work weakens the heart and can lead to heart failure, a condition in which the heart can no longer pump enough oxygen-rich blood to meet the body’s daily needs.

Many things can cause PH, including certain congenital heart defects; connective tissue disease; coronary artery disease (CAD); liver disease, such as cirrhosis; hypertension (high blood pressure); blood clots in the pulmonary artery; HIV; pulmonary fibrosis (a condition causing scarring in the lungs); chronic lung disease, such as emphysema; heart failure; and genetics. PH 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 of PH, such as shortness of breath and fatigue, are common to many other medical conditions. Therefore, diagnosis is often delayed until more serious symptoms develop, such as dizziness, chest pain, ankle swelling and palpitations. Because PH may be caused by many conditions, a doctor must perform a thorough medical history and physical exam, including a detailed discussion of symptoms to make a diagnosis and rule out other disorders. The 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 the lungs and right ventricle. The doctor may recommend an echocardiogram, which uses sound waves to create moving pictures of a beating heart. This shows blood flow through your heart. A right heart catheterization can confirm the diagnosis of PH.

There’s currently no cure for PH, but treatment is available to help improve signs and symptoms and slow the progression of the disorder. The treatment will depend, in part, on the cause of PH and will focus on treating the cause. However, certain treatments are generally always used. Medications such as diuretics, or water pills, reduce fluid build-up in the 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 the heart beat stronger and pump more blood. A doctor may recommend oxygen therapy to raise the level of oxygen in the blood. If medications don’t control signs and symptoms, the doctor may recommend surgical procedures for PH such as atrial septostomy, an procedure to create 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 treatments. In these cases, the lungs or heart and lungs are removed and replaced with healthy organs from a donor. Certain lifestyle changes can help improve life with PH:

• Quit smoking. Smoking worsens symptoms of PH.
• 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 can affect how 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 PH 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. Available resources include counseling, medication and participation in a patient support group.