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Pulmonary hypertension
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Pulmonary hypertension

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ASTHMA & RESPIRATORY SYSTEM
Respiratory System

Pulmonary hypertension begins when tiny arteries in your lungs become narrow or blocked. This causes increased resistance to blood flow in your lungs, which in turn raises pressure within the pulmonary arteries. As the pressure builds, your heart's right ventricle must work harder to pump blood through your lungs, eventually causing the heart muscle to weaken and sometimes to fail completely.

Treatment

The optimal treatment for each person with pulmonary hypertension differs from person to person. The treatments are often complex and require extensive follow-up care. What's more, your doctor may need to change a therapy during the course of treatment because it's no longer effective. The best approach for you will depend on a number of factors, including your age, type of pulmonary hypertension and overall health. When pulmonary hypertension is the result of another condition, your doctor will treat the underlying cause whenever possible.

Treatments for pulmonary hypertension include the following:

  • Blood vessel dilators. Prostacyclin is a prostaglandin — a substance that acts much like a hormone. It's produced naturally in the cells that line your blood vessels, but it's also now manufactured as a drug that acts as a powerful blood vessel dilator (vasodilator) and anti-clotting agent. Epoprostenol (Flolan) may help lessen symptoms such as shortness of breath and chest pain by improving the function of the pulmonary blood vessels. It may also prevent fainting spells, improve your stamina and reduce the risk of blood clots. The drawback to epoprostenol is that it lasts only a few minutes in circulation and must be continuously infused through an intravenous (IV) catheter via a small pump that you wear in a pack on your belt or shoulder. This form of therapy is complex. It requires that you learn to prepare your own medication mixture, operate the pump and care for the IV catheter. You must also receive comprehensive follow-up care. Yet epoprostenol controls symptoms and helps prolong life better than other therapies do. Potential side effects of epoprostenol include jaw pain, nausea, diarrhea, leg cramps, as well as pain and infection at the IV site.

  • Endothelin receptor antagonists. These medications, available in pill form, work to reverse the effect of endothelin, a substance in the walls of blood vessels that causes constriction and narrowing. Bosentan (Tracleer), one type of endothelin receptor antagonist, may improve the stamina of people with pulmonary hypertension as well as help relieve symptoms. The drug isn't for pregnant women, and people who do take it need monthly liver monitoring.

  • High-dose calcium channel blockers. These drugs, which help relax the muscles in the walls of the blood vessels, are commonly used to treat systemic hypertension. They include medications such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac) and nifedipine (Adalat, Procardia). Although calcium channel blockers can be very effective in some people, only about one in five people with pulmonary hypertension respond to these medications. In addition, calcium channel blockers can cause significant, and sometimes serious, side effects.

  • Anticoagulants. Your doctor is likely to prescribe the anticoagulant warfarin (Coumadin) to help prevent the formation of blood clots. As with all medications, anticoagulants have both risks and benefits. Because anticoagulants prevent normal blood coagulation, they increase your risk of bleeding complications. Many of these complications are minor, such as bleeding from your gums, but some may be severe and life-threatening. If you're taking warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working as well as tests for hidden (occult) blood in your stool. In addition, more than 100 other drugs, including over-the-counter medications and some herbs, can interact with anticoagulants, so be sure your doctor knows all of the medications you're taking.

  • Diuretics. Commonly known as water pills, these medications help eliminate excess fluid from your body, which reduces the amount of work your heart has to do. They also may be used to limit fluid buildup in your lungs.

  • Oxygen. You're likely to be given oxygen therapy to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people with pulmonary hypertension eventually require constant oxygen therapy.

  • Transplantation. In rare cases, a lung or heart-lung transplant may be an option, especially for younger people who have primary pulmonary hypertension. The single-lung transplant is the most common transplant used for people with PPH. It has fewer complications than do double-lung or heart-lung transplants and often leads to considerable improvement in the functioning of the right ventricle. Major risks of any type of transplantation include rejection of the transplanted organ and serious infection, and you must take immunosuppressant drugs for life to help reduce the chance of rejection.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyclinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/15/08 02:00 AM