Pulmonary hypertension is a serious illness that has many treatments but no cure. It occurs when the pulmonary arteries have higher pressure than right ventricular pressure. This causes the right ventricle to pump blood to the lungs with decreasing efficiency. Over time, the effect combines to lower oxygen blood level, to cause shortness of breath and fatigue, to risk conditions like blood clots, and to create right heart failure and fluid overflow in the lungs. Available pulmonary hypertension treatment can slow down this process and address the greater risks of edema and dangerous blood clots; specifics of each person’s care vary and are based on health history and doctor discretion.
Two types of pulmonary hypertension are typically identified. A primary or idiopathic type occurs in absence of any other causal factors, and secondary pulmonary hypertension is usually caused by some condition that gradually impacts the pulmonary arteries. The causes can be varied and include some autoimmune diseases, congenital heart defects, illness in the left side of the heart, emphysema or chronic obstructive pulmonary disease (COPD), sleep apnea, stimulant medicines or street drugs, and cirrhosis of the liver.
Since pulmonary hypertension isn’t curable, effort is made to cure or address conditions that could create it. Kids with heart defects have early full repair of anomalies or palliative surgeries like banding of the main pulmonary artery to avoid right heart and lung damage. Treatments to improve left heart function or sleep apnea, and programs to get people off street drugs might help prevent this disease.
In the absence of successfully timed preventative techniques, a number of pulmonary hypertension treatment medications may help the right ventricle function more efficiently and reduce resistance in the pulmonary arteries. One common treatment is to use special vasodilators that help open pulmonary arteries. Medications most used are epoprostenol and iloprost. The first is continuously injected into the body through a small catheter that is portable, and the second is inhaled from a nebulizer. Other vasodilators might also be considered.
Another pulmonary hypertension treatment is the drug bosentan. It enlarges blood vessels by reducing their endothelial lining, which can thicken and cause blockage. Other medicines may open the blood vessels, and groups of drugs like calcium channel blockers in very high doses can relax blood vessel tension and promote better flow.
In addition to medications that may provide pulmonary hypertension treatment, some treatments help to reduce side effects or risks. Patients may need oxygen, and most need blood thinners like warfarin to prevent possibility of forming blood clots. Other drugs like furosemide, a diuretic, are commonly used to reduce fluid overload.
Occasionally doctors recommend surgery as part of pulmonary hypertension treatment, though it is risky and not available to all people. One surgery, atrial septostomy, creates a hole between the atria, which can reduce flow of blood from right side of the heart to the pulmonary arteries. Another option is heart lung transplant, but thus far, these transplants don’t have encouraging survival rates and they are difficult to obtain.