Pulmonary hypertension is serious, but treatment is available
By Jay Nachman
You are probably familiar with the term hypertension, which means high blood pressure. Pulmonary is a lesser-known term. It refers to the arteries that carry blood from the right side of the heart to the lungs. A serious health condition, called pulmonary hypertension, is elevated blood pressure in the arteries of the lungs.
Pulmonary hypertension is often undiagnosed because its symptoms are similar to those of many more common conditions. These symptoms include shortness of breath, lightheadedness, chest pain and leg swelling. “The key to a successful outcome is to recognize (pulmonary hypertension) symptoms early, so they can (begin a) course of treatment,” said Dr. Ahmed S. Sadek, pulmonary hypertension specialist at Temple Health’s Heart and Vascular Institute.
Unlike high blood pressure throughout the body, pulmonary hypertension involves only the pulmonary arteries. It can lead to right-side heart failure over time. An ultrasound of the heart, called an echocardiogram, can detect signs of pulmonary hypertension. Certain forms of pulmonary hypertension may be caused by blood clots and can eventually lead to strain on the right side of the heart.
The current standard in cardiology care is to “prevent bad outcomes before they happen,” Dr. Sadek said. So, while some heart disease may be genetic, preventive actions can help keep the disease under control. For example, limiting salt (also called sodium) is crucial. Salt causes the body to retain fluid and can make leg swelling worse, according to Dr. Sadek.
Being sedentary is also a risk factor. Long periods of sitting or inactivity can increase the risk of clots in the legs. These clots can travel to the lungs. Smoking can also lead to lung disease, which may then lead to pulmonary hypertension, Dr. Sadek said. If a blood clot is caught early, blood thinners are a practical treatment. However, if a clot is identified too late, scar tissue can form in the arteries. When this happens, pulmonary hypertension can become a chronic problem. In this situation blood thinners will prevent new clots from forming. But it cannot reverse the scar tissue that has formed.
There are two effective treatments for the condition called chronic thromboembolic pulmonary hypertension: balloon pulmonary angioplasty and pulmonary thromboendarterectomy. Both procedures are specialties of Temple Health’s Heart and Vascular Institute, which has performed a combined 1,000 procedures.
Balloon pulmonary angioplasty (BPA) uses a small tube, called a catheter, inserted in a blood vessel in the arm or leg. When the tube is inflated, a small balloon slowly opens blood vessels that have been chronically blocked. This restores blood flow to the lungs, which reduces shortness of breath, fatigue and chest pain.
Pulmonary thromboendarterectomy (PTE) places the patient on a heart-lung machine to temporarily stop blood circulation. Surgeons can then remove blood clots and scar tissue that has formed in the pulmonary arteries. There are some cases that can only be treated by PTE surgery, while others can only be treated by catheters with BPA. Some patients can be treated by both. “It’s nice to have the option to do a less invasive procedure when it’s medically appropriate,” Dr. Sadek said.
Following surgery, patients are told to temporarily avoid heavy lifting, which might tug and pull on the chest that is healing. After one or two months, generally speaking, restrictions can be removed.
“The majority of patients are amazed by how much better they feel after surgery,” Dr. Sadek said. “They tend to be thankful for the functional improvements, and the things that they’ve been able to go back to doing. These are the things that they enjoyed in their everyday life before the clots started to develop.”
Several patients in their 70s and 80s have undergone successful procedures. Dr. Sadek said, “Just because they are older adults doesn’t mean we write them off for these procedures. It’s all individualized based on the patient.”
Jay Nachman is a freelance writer in Philadelphia who tells stories for a variety of clients.
