Pulmonary Hypertension: A Good Reason to Use Supplemental Oxygen

Pulmonary hypertension (PH) is a type of high blood pressure that affects the tiny blood vessels in your lungs, known as the pulmonary arteries and capillaries. It begins when the pulmonary vessels become too narrow to accommodate the amount of blood that must be pumped through the lungs. As blood flow meets with resistance, pressure builds within the vessel walls, forcing the heart to work harder to try and pump blood through the lungs. Eventually, the heart grows tired and weak and a condition known as cor-pulmonale, or right-sided heart failure, may occur.¹

Will the Real PH Please Rise: Two Types of Pulmonary Hypertension

There are two types of pulmonary hypertension: pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH). PAH used to be called primary pulmonary hypertension while PH was called secondary hypertension. PAH occurs when the blood vessels in the lungs are directly diseased; PH is caused by another medical condition such as COPD, heart disease or blood clots.¹

Signs and Symptoms

Signs and symptoms of pulmonary hypertension include:¹

• Shortness of breath
• Chest pain
• Dizziness
• Fainting  or near-fainting
• Swelling in the feet, legs or abdomen
• Heart palpitations, racing or pounding pulse
• Bluish discoloration of lips and/or fingers

As the disease worsens, even minimal activity is enough to provoke any, or all, of the above symptoms.

Diagnosis

Because the signs and symptoms of pulmonary hypertension closely mimic those of many other health conditions, it is not easily detected during a routine physical exam.² If your doctor suspects pulmonary hypertension, or if PH is suspected when ruling out other conditions, she may order an ultrasound of your heart (echocardiogram). If the echocardiogram shows increased pressure in the right side of your heart, your doctor may then order a right-heart catheterization, the gold standard of PH diagnosis.¹

Treatment

Pulmonary hypertension is a progressive, sometimes fatal illness, for which there is no cure. However, treatment can ease the symptoms of pulmonary hypertension and lead to a better quality of life. Possible treatment options include:²

1. Supplemental Oxygen

• May be ordered if your blood oxygen levels are low.

2. Medications

• Vasodilators – open blood vessels improving blood flow and reducing strain on the heart.
• Calcium channel blockers – decrease blood pressure in a select group of patients.
• Digoxin – helps the heart pump better.
• Coumadin – helps to prevent blood clots by thinning the blood.
• Diuretics – rid the body of excess fluid that may put a strain on the heart.
• Endothelin Receptor Antagonists – prevent blood vessels from narrowing
• Phosphodiesterase Inhibitors (PDE 5 Inhibitors) – allow the lungs to produce more of their own, naturally occurring vasodilators.
• Prostacyclins – a type of inhaled medication that helps relieve shortness of breath
• Intravenous and Subcutaneous Medications – ease symptoms of PH such as shortness of breath and chest pain.

3. Pulmonary Rehabilitation

• Improves activity tolerance allowing you to become more active.
• Improves breathing.

4. Surgery

• Atrial septostomy – reduces pressure in the heart allowing it to pump more efficiently.
• Lung transplant – may be appropriate for a select group of patients who meet very strict criteria.

5. Lifestyle Changes
Lifestyle changes, as noted below, won’t cure pulmonary hypertension, but implementing them in your daily life may help improve symptoms related to it:²

• Rest
• Exercise
• Quit smoking
• Reduce stress
• Eat a healthy diet
• Maintain a healthy weight
• Avoid high-altitude travel
• Avoid activities that may lower blood pressure, such as hot tubs, saunas and hot baths

For more information or to find a doctor who specializes in PH visit the Pulmonary Hypertension Association.

Author: Deborah Leader RN, BSN, PHN