Pulmonary hypertension is a life-threatening condition that gets worse over time. Treatments can help your symptoms so you can live better with the disease. It may take some planning, but many people with it find ways to do all the things they love, just like they did before they were diagnosed.
When you have pulmonary arterial hypertension (PAH), the arteries that lead from your heart to your lungs have high blood pressure. It’s not the same as having high blood pressure all the time.
When you have PAH, the small arteries in your lungs get blocked or narrowed. Blood has a harder time getting through them, which raises the blood pressure in your lungs. Your heart has to work harder to get blood through those arteries, and over time, the heart muscle gets weaker because it has to work harder. It can lead to heart failure in the long run.
Causes
High blood pressure in the lungs doesn’t always have a clear cause. Idiopathic pulmonary hypertension is the name for this type of high blood pressure in the lungs. Some people may get it because of their genes.
In other situations, the problem is caused by something else. High blood pressure in the lungs can be caused by any of the following:
Congestive heart failure (CHF)
Clots of blood form in the lungs
HIV Illegal drug use (like cocaine or methamphetamine)
Liver sickness (such as cirrhosis of the liver)
Lupus, scleroderma, rheumatoid arthritis, and many other autoimmune diseases
A birth defect of the heart
Lung diseases like emphysema, bronchitis that doesn’t go away, and pulmonary fibrosis
Signs of sleep apnea
You might not feel anything for a while. The main one is having trouble getting enough air when you’re active. Most of the time, it starts out slowly and gets worse over time. You might find that you can’t do some things as easily as you used to.
Some other signs are:
Chest pain
Fatigue
Passing out
Swelling in your ankles and legs
Receiving a Diagnosis
If you go to the doctor because you can’t get enough air, they will ask you about your health history. They may also ask you:
Do you smoke?
Does anyone in your family have problems with their heart or lungs?
When did you first feel sick?
What helps or hurts your symptoms?
Does it ever get better?
Your doctor may want to do tests like:
Echocardiogram: With this picture of the beating heart taken with an ultrasound, the blood pressure in the pulmonary arteries can be measured.
A CT scan can show if the pulmonary arteries are too big. A CT scan can also find other problems in the lungs that could cause shortness of breath.
Ventilation-perfusion scan (V/Q scan): This test can help find blood clots that cause high blood pressure in the lungs.
Electrocardiogram (EKG or ECG): An EKG records the activity of the heart and can show if the right side of the heart is being overworked. This is a sign that you may have pulmonary hypertension.
X-ray of the chest: An X-ray can show if your arteries or heart are bigger than normal. X-rays of the chest can help find other conditions in the lungs or heart that could be causing the problems.
Practice tests: Your doctor may want you to run on a treadmill or ride a stationary bike while they watch your oxygen levels, heart function, lung pressure, and other things.
Your doctor may also check your blood for HIV and diseases like lupus or rheumatoid arthritis.
If these tests show that you may have pulmonary hypertension, your doctor will need to do a right heart catheterization to be sure. During that test, these things happen:
The doctor threads a catheter into the right side of your heart through a large vein, usually the jugular vein in your neck or the femoral vein in your leg.
Pressures in the right side of the heart and the pulmonary arteries are measured by a monitor.
The doctor may also use the catheter to inject medicine into the pulmonary arteries to see if they are stiff. A vasoreactivity test is what this is.
Putting a catheter in the right heart is safe. The doctor will give you something to make you sleepy and use a local anesthetic. Most of the time, you can go home the same day, but you’ll need someone to drive you.
Treatment
Pulmonary hypertension can look different in different people, so your treatment plan will be made just for you. Ask your doctor about your choices and what you can expect.
First, your doctor will take care of what’s making you sick. For instance, if the problem is caused by emphysema, you’ll need to treat that to get rid of pulmonary hypertension.
Most people also get treatment to help them breathe better, which makes it easier to be active and do daily tasks. When you do oxygen therapy, you breathe pure oxygen through prongs that fit in your nose. This can help if you have trouble getting enough oxygen in your blood and are short of breath. If you have pulmonary hypertension, it helps you live longer. If you are likely to get blood clots, your doctor will probably tell you to take blood thinners. Other medicines help your heart work better and keep your body from getting too full of fluid.
If your pulmonary hypertension is very bad, your doctor may give you calcium channel blockers. The blood pressure in the lungs and the rest of the body goes down when you take these medicines.
If calcium channel blockers don’t work, your doctor may send you to a treatment center that specializes in your condition. You may need more targeted treatments that can help open up your blood vessels that have become narrow. They could be pills, medicines you breathe in, or drugs that are given through an IV. Some choices are:
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In more serious cases or if medicines don’t help, your doctor may suggest a lung transplant or a procedure called atrial septostomy. A hole is made between the right and left sides of the heart by a surgeon. Some of the side effects of this surgery can be very bad.
How to Look After Yourself
Even if you have trouble breathing, staying active is one of the best things you can do for yourself. Walking or another regular exercise will help you breathe better and live longer. Talk to your doctor first to figure out how much and what kind of exercise is best for you. When they work out, some people may need to use oxygen.
Get a lot of rest as well. Pulmonary hypertension makes you tired, so get a good night’s sleep and nap when you need to.
You should eat a healthy diet with lots of fruits, vegetables, and whole grains, just like everyone else. That’s good for your health as a whole.
What to Look For
A lot depends on what is causing the high blood pressure in your lungs. If you treat the underlying problem, you will feel better. Pulmonary hypertension can’t be cured, but it’s easier to deal with if it’s found early on.
If you have idiopathic pulmonary hypertension, which is a type of high blood pressure in the lungs for which doctors can’t find a cause, your symptoms may get worse over time. But treatment can stop the disease from getting worse and make you live longer.
Keep in mind that everyone is different, and there are good ways to help. Work with your doctor to figure out what you should do.