Who Gets Pulmonary Hypertension
Pulmonary hypertension is a rare condition that can affect people of any age. According to the NHS, its more common in people who have another lung or heart condition. PH can also be associated with other medical conditions such as connective tissue conditions, congenital heart disease, HIV, genetic causes, or it can happen by itself. Read more about the different types of PH and what causes it.
According to the Pulmonary Hypertension Association UK, PH is more common in women. Studies have shown that the female sex hormone is a risk factor for pulmonary arterial hypertension , with PAH around four times more likely in women.
Improving Drug Delivery: A Way To Improve Adequacy With Treatment Algorithms
Use of parenteral prostanoids in 192 patients with pulmonary arterial hypertension in functional class IV at the time of all-cause mortality. Results from the US REVEAL registry. Data from .
A room temperature stable epoprostenol, Veletri , has been approved in some countries. Reconstituted solutions can be used at room temperature for up to 72 h and no ice packs are required . The effect of transitioning patients from epoprostenol requiring ice pack use to room temperature stable epoprostenol was assessed and demonstrated that patients receiving the latter reported increased treatment convenience, while clinical efficacy measures and safety profile remained consistent . Three patients reported device-/catheter-related infections, all of which were local infections with no evidence of bacteraemia.
An oral therapy targeting the prostacyclin receptor could offer improved convenience over current i.v. therapy and might encourage greater clinical use. The FREEDOM trials evaluated the efficacy and safety of oral treprostinil, a prostanoid recently approved by the US Food and Drug Administration, in patients with or without background PAH-specific therapy however, the proportion of functional class IV patients was low . Selexipag, an investigational oral, selective prostacyclin receptor agonist, is currently being investigated in > 1000 patients with PAH in a multicentre, double-blind, phase III, long-term, event-driven study .
Which Types Of Doctors Treat Pulmonary Hypertension
Generally, pulmonary physicians and cardiologists treat pulmonary hypertension. Depending on the cause, other physicians also may be involved, such as sleep medicine doctors, rheumatologists, and perhaps even infectious disease specialists. Today, more health care professionals in the community are becoming adept at managing pulmonary hypertension. However, it is reasonable to get a second opinion regarding management at a tertiary, university setting, because the field of management of pulmonary artery hypertension is evolving rapidly.
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No Matter The Type Ph Is A Serious Disease
If left untreated, PH can lead to right heart failure and death. Fortunately, because of major advancements made in the past two decades, therapies that target the pulmonary arteries are available to help relieve symptoms, improve quality of life and slow down the progression of the disease in patients with WHO Group 1.
Patients with WHO Groups 2 and 3 can benefit from treating the underlying left heart and lung diseases, respectively. Patients with WHO Group 4 can benefit from either a surgery to remove the clots or a PH-targeted therapy if they are unable to have the surgery or have PH remaining after the surgery.
Survival Rates And Prognosis
Theres currently no readily available cure for PH. Its a progressive disease, which means it can advance over time, sometimes much faster for some people than others. If left untreated, the disease can become life-threatening within a couple of years.
However, the disease can be managed. Some people can effectively make lifestyle changes and monitor their health. But for many people, PH can lead to significant heart failure, and their overall health can be in great danger. Medications and lifestyle modifications are intended to slow the progression of the disease.
If you have PH and systemic scleroderma, an autoimmune skin disease that also affects the small arteries and internal organs, your two-year survival odds are estimated to be 40 percent, according to a 2008 study. Survival rates with PH depend on the cause of the condition.
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Treatment Of Chronic Thromboembolic Pulmonary Hypertension
Surgical pulmonary endarterectomy is the treatment of choice.
Nowadays around 50 to 70% of patients with chronic thromboembolic pulmonary hypertension are operable . Riociguat is a licensed drug treatment for nonoperable patients and those with residual pulmonary hypertension after pulmonary endarterectomy . In the event that riociguat does not achieve the desired improvement, the currently valid guidelines recommend the use of other medications for pulmonary arterial hypertension, although these have not been licensed for this indication . In the past few years, moreover, some centers for chronic thromboembolic pulmonary hypertension have been evaluating pulmonary balloon angioplasty as a new interventional treatment option. This procedure can be used to recanalize obliterated pulmonary vessels at the peripheral, i.e., subsegmental level . The results to date are encouraging. For the time being, however, this method should be restricted to experienced centers for chronic thromboembolic pulmonary hypertension.
Group : Ph Due To Lung Disease And Hypoxia
Group 3 PH is caused by a lack of oxygen over extended periods of time, known as hypoxia. This can be caused by several conditions, including sleep apnea, interstitial lung disease, and chronic obstructive pulmonary disease. People who live at higher altitudes with lower oxygen levels can also develop group 3 PH.
People with chronic obstructive pulmonary disease and PH have been found to have better survival rates than those with interstitial lung diseases and PH. The five-year survival rates for group 3 PH are 44 percent for women and 34.3 percent for men. It has also been found that survival rates are better for those with less severe heart failure symptoms using the New York Heart Association scale.
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What Should You Know About Living With Chronic Thromboembolic Pulmonary Hypertension
- You will have to be on blood-thinners for the rest of your life. Warfarin is preferred, but you might be able to switch to newer anticoagulants after a period of time.
- Your healthcare provider may suggest a low-salt diet. In addition, you might have to be careful with some foods and drugs as a result of taking blood-thinners.
- Your healthcare provider might suggest exercise, such as walking, as tolerated.
- Your doctor might decide to insert an inferior vena cava filter into your abdomen to stop clots from moving upward from the legs.
Pah Affects Women More Than Men
The idiopathic and heritable forms of PAH are at least twice as common in women compared to men, according to the Pulmonary Hypertension Association. In fact, PAH is most often diagnosed in women between the ages of 30 and 60.
It’s not currently known why females are more susceptible, but some theories under investigation have to do with the role of estrogen, changes that occur during pregnancy and links to autoimmune issues, which also tend to be more prevalent in women.
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Further Information On Cme
This article has been certified by the North Rhine Academy for Postgraduate and Continuing Medical Education. Deutsches Ärzteblatt provides certified continuing medical education in accordance with the requirements of the Medical Associations of the German federal states . CME points of the Medical Associations can be acquired only through the Internet, not by mail or fax, by the use of the German version of the CME questionnaire. See the following website: cme.aerzteblatt.de.
Participants in the CME program can manage their CME points with their 15-digit uniform CME number . The EFN must be entered in the appropriate field in the cme.aerzteblatt.de website under meine Daten , or upon registration. The EFN appears on each participants CME certificate.
This CME unit can be accessed until 30 April 2017, and earlier CME units until the dates indicated:
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Treatment Options in Hepatitis C until 2 April 2017, and
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the Differential Diagnosis of Dyspnea until 5 March 2017.
Please answer the following questions to participate in our certified Continuing Medical Education program. Only one answer is possible per question. Please select the most appropriate answer.
Question 1
Pulmonary arterial hypertension is characterized by which of the following hemodynamic criteria?
Systolic pulmonary artery pressure > 40 mm Hg
Mean pulmonary artery pressure 25 mm Hg at rest and > 30 mm Hg on exercise pulmonary arterial wedge pressure 15 mm Hg
Question 2
12 per 1 million adults
Angio-CT
What Is Primary Arterial Hypertension
Pulmonary arterial hypertension , formerly known as primary pulmonary hypertension, is a rare type of high blood pressure.
PAH affects the pulmonary arteries and capillaries. These blood vessels carry blood from the lower right chamber of your heart into your lungs.
As the pressure in the pulmonary blood vessels builds up, the heart must work harder to pump blood to the lungs. Over time, this weakens the heart muscle. Eventually, it can lead to heart failure and death.
Theres no cure yet for PAH, but treatment options are available. Treatment may help relieve your symptoms, lower your chance of complications, and prolong your life.
In the early stages of PAH, you might not have any noticeable symptoms. As the condition worsens, symptoms will become more noticeable. Common symptoms include:
- difficulty breathing
If your doctor suspects you might have PAH, they will likely order one or more tests to assess your pulmonary arteries and heart.
Tests for diagnosing PAH may include:
Your doctor can use these tests to check for signs of PAH as well as other potential causes of your symptoms. Theyll try to rule out other potential causes before diagnosing PAH. Get more information about this process.
Currently, theres no known cure for PAH, but treatment can ease symptoms, reduce the risk of complications, and prolong life.
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How Do The Heart And Lungs Work Together
Image showing how the heart and lungs work together
Caring For Someone With Pulmonary Hypertension
Pulmonary hypertension usually progresses slowly, and eventually results in shortness of breath and a decreased ability to perform the activities of daily living at home. For most of the course of the illness you will not need any extra assistance at home. However, at the end stage of pulmonary hypertension, you may need services such as home oxygen, council cleaning, and meals on wheels. These can be arranged through your GP or local volunteer services.
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Persistent Pulmonary Hypertension Of The Newborn
This is a type of pulmonary hypertension estimated to affect two in every 1,000 newborn babies.
It has been linked to the mother taking non-steroidal anti-inflammatory drugs during the third trimester of the pregnancy .
Conditions that may also be associated with persistent pulmonary hypertension of the newborn include:
- severe pulmonary hypoplasia when your babys lungs are seriously underdeveloped
- hypoglycaemia an abnormally low level of glucose in the babys blood
- a life-threatening illness caused by the babys body overreacting to an infection
- meconium aspiration syndrome when a newborn baby breathes in a mixture of amniotic fluid and meconium , which can block their airways
Research Into Pulmonary Hypertension
Pulmonary hypertension is an area of intense research, particularly with respect to:
- the correct type of medication to use in the different groups of pulmonary hypertension, and in which combinations
- management of right heart failure, and possible new treatment targets or therapies
- treatments at the molecular level, such as monoclonal antibodies, which may be useful tools to slow disease progression
- further genetic markers that may identify people at high-risk of developing pulmonary hypertension.
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Symptoms Of Pulmonary Hypertension
- a racing heartbeat
- swelling in the legs, ankles, feet or tummy
The symptoms often get worse during exercise, which can limit your ability to take part in physical activities.
If you have a type of pulmonary hypertension known as pulmonary arterial hypertension , you may not have any symptoms until the condition is quite advanced.
Pulmonary Versus Systemic Blood Pressure
Unlike systemic blood pressure, which represents the force of your blood moving through the blood vessels in your body, pulmonary blood pressure reflects the pressure the heart exerts to pump blood from the heart through the arteries of the lungs. In other words, it focuses on the pressure of the blood flow in your lungs.
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What Are The Complications/side Effects Of The Treatments Of Chronic Thromboembolic Pulmonary Hypertension
PTE surgery is delicate. If you have the surgery, you should expect to be in the hospital for about 10 days after surgery. The breastbone takes about two months to heal. You should be able to resume almost all activities by three months after PTE.
If you take Adempas® to treat CTEPH, you might have the following side effects:
- Stomach issues, including nausea.
Untreated, CTEPH gets worse and can be fatal.
Pah And Lung Transplantation: Bridging The Gap
There are a number of bridging techniques available for physicians to prepare patients with severe PAH for lung transplantation. The decision-making process to choose a particular bridging technique is complex, and may be based on the severity of the patients illness and the anticipated wait between bridging and transplantation.
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Outcomes Following Lung Transplantation
The response of the right ventricle to lung transplantation is immediate. While patients are often admitted for surgery on combination vasodilator therapy, they may be able to stop these medications post-operatively . Haemodynamic improvements are also evidenced instantly and significant improvements in mean pulmonary artery pressure have been demonstrated directly following lung transplantation .
Early complications after lung transplantation may include primary graft dysfunction, pneumonia, acute cellular rejection, problems with anastomoses and antibody-mediated hyperacute rejection . Most rejections of transplanted lungs occur within the first 6 months . Other complications following transplantation include infection, airway complications, renal failure, cardiovascular complications and cancer .
Pulmonary Hypertension Life Expectancy
Pulmonary hypertension is a chronic and progressive disease characterized by high blood pressure in the pulmonary arteries, the blood vessels of the lungs.
There are many potential causes of the disease that, along with how early the disease is diagnosed and when treatment is started in the patient, can affect prognosis.
There is currently no known cure for pulmonary hypertension, but research is ongoing, and with the continual improvement of diagnostic techniques and therapies, it is becoming possible to diagnose the disease earlier to manage the symptoms for longer.
Pulmonary hypertension is a progressive disease, which means it worsens over time, although the speed varies based on the individual and the class of pulmonary hypertension. If left untreated, the prognosis is poor and the disease is often fatal within a few years, emphasizing the need for a quick and accurate diagnosis.
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Treatment For Pulmonary Hypertension
If you are diagnosed with pulmonary hypertension you will have three- to twelve-monthly reviews, depending on:
- the severity of your illness
- the cause of your pulmonary hypertension
- the treatment you are receiving.
You will be encouraged to make healthy lifestyle changes. You can reduce your risk of worsening pulmonary hypertension by maintaining a healthy weight, exercising regularly and avoiding smoking. A healthy diet and moderate amounts of exercise are proven to be of benefit in improving effort tolerance and reducing symptoms. Your treating doctor will issue the appropriate referrals to ensure that any underlying medical conditions contributing to your pulmonary hypertension are managed by the appropriate specialists.Your GP will help you to lower your cardiovascular risk by treating high cholesterol, diabetes, or high blood pressure. It is important to tell your GP or specialist if you are feeling overwhelmed, as they may be able to help you or refer you to someone who can. They may refer you to a counsellor or psychologist who can help you cope with the changes your symptoms make to your everyday life.
The Exact Cause Of Pah Is Unknown But Physiological Changes Are Key To Its Development And Progression
PAH is diagnosed when mean, or average, blood pressure leaving the arteries on the right side of the heart is measured at 25 mmHg or higher. No one knows exactly what kicks off the chain of events that sets PAH in motion, but experts do know a lot about how it progresses.
“It starts with constriction of these vessels and leads to remodeling of the vessel wall,” says Alessandro Maresta, M.D.Alessandro Maresta, M.D.,Vice President and Head of Global Medical Affairs, Actelion Pharmaceuticals, Vice President and Head of Global Medical Affairs for Actelion Pharmaceuticals, a Swiss biotech company that Johnson & Johnson acquired in June of this year. “As the walls of the blood vessels thicken, the lumenthe space where blood flows throughgets smaller, and the pressure goes up. As the disease progresses, pressure continues to rise, but the right ventricle of the heart is not designed to pump blood against such high pressure.”
As the condition worsens, “patients tend to become very tired and short of breath,” says Nazzareno Galié, M.D., professor of cardiology and Director of the Specialization School of Cardiology, University of Bologna, Italy. “Some people might notice heart palpitations or feel chest pressure, especially when exercising.”
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