Pulmonary Hypertension Treatment

  • Treatment

    Pulmonary hypertension can lead to a heart attack or heart attack-like symptoms. You should seek emergency care immediately if you start to experience the symptoms noted below.

    • Chest discomfort—crushing, squeezing, or pain in the center of the chest that lasts more than a few minutes or that goes away and comes back
    • Pain or discomfort in other areas of the upper body, such as the arms, neck, jaw, back, or stomach
    • Shortness of breath or difficulty breathing
    • Heavy sweating or nausea
    • Pale or bluish lips, fingernails, or skin
    • Dizziness

    You should call your healthcare provider if you are experiencing frequent fatigue and shortness of breath after light physical activity.

    Although there is no cure, doctors recommend that people with pulmonary hypertension adopt some healthful lifestyle changes to make living with the disease easier.

    • Don't smoke. Ask your health care provider for medications and/or programs that can help you quit.
    • Breathe cool, dry, clean air whenever possible. Avoid second-hand smoke, dust, and chemical fumes.
    • If you live at a high altitude, consider moving to a low one. More oxygen is in the air at low altitudes, which will make it easier for you to breathe.
    • Eat a well-balanced diet. Make sure you eat plenty of foods rich in antioxidants, especially vitamin E, vitamin C, and beta-cryptoxanthin (a carotenoid found mainly in oranges); these nutrients have been found to improve lung function. The best sources of antioxidants are fruits and vegetables.
    • Stay physically active as much as possible, but don’t overdo it. Walking is an excellent exercise for people with pulmonary hypertension. If you are using portable oxygen, simply take it with you on your walks.
    • Avoid lifting weights, stair climbing, and other isometric exercises. Such activities may cause you to faint.
    • Get plenty of rest.
    • To reduce stress and improve breathing, practice relaxation techniques, such as progressive relaxation or meditation.
    • Take your medications as prescribed by your doctor.
    • Do not use any nonprescription drugs (especially decongestants and nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen), vitamins, herbs, or alternative medications without discussing them first with your doctor. Such substances may interfere with medications prescribed for your pulmonary hypertension.
    • If you are being treated for high blood pressure (hypertension), you should avoid using beta blockers, which can aggravate pulmonary hypertension.
    • Do not take diet drugs.
    • Do not use cocaine or other illicit drugs.
    • If you are a woman of childbearing age, avoid becoming pregnant. Pregnancy can be life-threatening for someone with pulmonary hypertension.
    • If you are a woman of childbearing age, do not use birth control pills. Ask your doctor about other methods of contraception.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Some people with pulmonary hypertension require oxygen replacement therapy, either occasionally (after physical exertion) or continuously. Several different oxygen-delivery devices are available for home use, including tanks of compressed gaseous oxygen and devices that concentrate oxygen from room air. With portable devices, you can take the oxygen with you as you go about your everyday activities.

    Lung transplantation is considered for people with advanced pulmonary hypertension whose condition has not responded to drug treatment. Sometimes, if the heart has been damaged or is dysfunctional, people receive a new heart as well as new lungs. The survival rates for people with pulmonary hypertension who have received transplants range from 70% to 75% at one year, 55% to 60% at three years, and 40% to 45% at five years.

    Other procedures can sometimes help people with pulmonary hypertension.

    If your pulmonary hypertension has resulted in chronic blood clots, you may benefit from a type of surgery known as thromboendarterectomy, which removes blood clots from arteries. If your pulmonary hypertension has caused severe right-sided heart failure, your doctor may recommend that you undergo balloon atrial septostomy, a nonsurgical procedure that uses a catheter to widen a naturally occurring hole in the wall (septum) between the two upper chambers of the heart (atria).

    Some herbs can interfere with medication used to treat the disorder. Therefore, you should never use alternative therapies for pulmonary hypertension without first getting your doctor’s approval. Garlic (Allium sativum), ginkgo biloba, ginger (Zingiber officinale), and feverfew (Tanacetum parthenium) can increase the potency of anticoagulants, for example. Other herbs, such as aloe vera, increase potassium loss and may interfere with the effectiveness of prescribed diuretics. In addition, Papilionacea crotalaria, a plant used to make herbal tea in parts of Africa and the Caribbean, has been linked to the development of pulmonary hypertension.

    Women with pulmonary hypertension must avoid becoming pregnant. During pregnancy, blood volume increases, which makes the heart work harder—a life-threatening situation for a woman with pulmonary hypertension who already has a weakened heart.

    If you are a woman of childbearing age and have been diagnosed with pulmonary hypertension, you will need to use an effective form of contraception. Because they increase the risk of blood clots, oral contraceptives are not recommended for women with pulmonary hypertension. Discuss with your health care provider which methods of contraception will work well for you.

    Until recently, the prognosis for pulmonary hypertension was grim. Today, however, as the result of new treatments, some people with the condition—even those who’ve already experienced heart damage—survive for more than 10 years after first receiving their diagnosis.

    The 5-year survival rate is 94% for people whose pulmonary hypertension has responded to long-term therapy with calcium channel blockers combined with anticoagulants. For those taking intravenous epoprostenol therapy, the 5-year survival rate is 54%. For those who have undergone a lung transplant, the 5-year survival rate is 45%.

    The prognosis for people with secondary pulmonary hypertension depends on the underlying disease and how much the right ventricle of the heart has weakened. For example, people with chronic obstructive pulmonary disease (COPD)—a common cause of secondary pulmonary hypertension—have a 3-year survival rate of 50% after their right ventricle begins to fail.

    In hopes of improving these survival rates, scientists are developing and testing many new and potentially more effective therapies. Such therapies include medications that are taken orally, inhaled, or delivered by skin patch. Scientists are also exploring the possibility of treatments involving gene therapy.

    People with pulmonary hypertension should remain under the ongoing care of a doctor. How frequently you see your doctor will depend on the severity of your condition and the type of medication you are taking. If you are taking calcium channel blockers or epoprostenol, you will need to be monitored frequently by your doctor so that your dosage can be altered, if necessary, to better treat your symptoms.

    Call your doctor immediately if your fatigue worsens; your medication may need adjustment.

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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