Pulmonary hypertension

High blood pressure in the lungs can leave you tired and out of breath. At Aurora Health Care, our heart and lung specialists can help. Our experienced team can evaluate you to find the cause of your pulmonary hypertension and plan your care using the latest treatment options for pulmonary hypertension.

What is pulmonary hypertension?

Pulmonary hypertension is high blood pressure that affects arteries in your lungs. Blood is pumped from the right side of your heart to the lungs, where it picks up oxygen. The oxygen-rich blood returns to the left side of your heart, which then pumps it to the rest of your body.

In people with pulmonary hypertension, the small lung (pulmonary) arteries become narrowed, thickened or damaged, making it harder for blood to circulate through your lungs. As blood pressure increases in these vessels, the right side of your heart works harder to force blood through them. Over time, this side of your heart may enlarge and become weaker and may not be able to keep up with your body’s demands.

Our  passed the Pulmonary Hypertension Association's rigorous accreditation process. This recognition shows our significant expertise in managing care for people with this complex condition. Find out more about our Pulmonary Hypertension Clinic at Aurora St. Luke’s Medical Center.

Pulmonary hypertension is sometimes referred to as:

• Pulmonary heart disease
• Pulmonary arterial hypertension (PAH)
• Chronic thromboembolic pulmonary hypertension (CTEPH)

Pulmonary hypertension causes

Sometimes the cause of pulmonary hypertension isn’t clear because there are many known causes.

Heart diseases that cause pulmonary hypertension

• Congenital heart disease (present at birth)
• Failure of the left ventricle (lower left heart chamber)
• Left-sided heart valve disease, such as mitral valve disease or aortic valve disease

Other health conditions that cause pulmonary hypertension

• Chronic blood clots in the lungs (pulmonary embolism) and certain blood disorders that increase the risk of blood clots (thrombophilia)
• Conditions that affect organs other than the heart, such as cirrhosis of the liver, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis or lung tumors
• Connective tissue disorders, such as lupus or scleroderma
• HIV infection
• Inflammatory disorders, such as sarcoidosis
• Metabolic disorders, such as thyroid disease
• Some types of anemia, including sickle cell disease

Other causes of pulmonary hypertension

• Genetic mutations (changes) passed down through families
• Long-term exposure to low-oxygen conditions, such as high altitudes and sleep apnea
• Long-term inactivity, such as bed rest or lengthy plane or car trips
• Spleen removal
• Use of certain prescription diet pills or illegal drugs, such as methamphetamines

Pulmonary hypertension risks

Pulmonary hypertension happens at all ages and becomes more frequent as people get older. It’s more common among women, Black people who are non-Hispanic and in people older than 75.

Pulmonary hypertension symptoms

You may not experience signs and symptoms of pulmonary hypertension at first because they often develop gradually. As pulmonary hypertension worsens, you may notice symptoms such as:

• Chest pain or pressure
• Decreased appetite
• Dizziness or fainting (syncope)
• Dry cough, hoarseness or wheezing
• Fatigue (tiredness) and weakness
  
• Heart palpitations
• Shortness of breath, at first with physical activity and later without it as the condition worsens
• Swelling caused by excess fluid in your ankles, legs and eventually in your abdomen

Pulmonary hypertension complications

The main complication of pulmonary hypertension is right heart failure. When the pulmonary arteries on the right side of your heart become narrowed or blocked, it has to work harder to pump blood through your lungs.

The right side of your heart first tries to keep up by thickening its walls and expanding the size of the right ventricle (lower right heart chamber). If left untreated, eventually the right ventricle fails.

Pulmonary hypertension can lead to other, possibly life-threatening conditions, including:

 

• Arrhythmia, an irregular heartbeat
• Bleeding in the lungs and coughing up blood
• Blood clots in the small arteries in your lungs
• Damage to other organs including the liver and kidneys
• Pericardial effusion, fluid buildup in the tissue sac surrounding the heart
• Pregnancy complications that can be life-threatening for mother and baby
• Syncope (fainting)

Pulmonary hypertension diagnosis

We’ll begin our evaluation by asking you about your medical history and potential pulmonary hypertension symptoms. We then do a complete physical exam, including pulse oximetry to measure your blood oxygen levels. You may also undergo one or more diagnostic tests so we can make an accurate pulmonary hypertension diagnosis.

You can usually receive testing at any of our outpatient locations before your first appointment with our cardiologists. We also can do many tests the same day as your visit, so you won’t have to make multiple trips. Find out more about our heart and vascular testing and diagnosis.

Tests to diagnose pulmonary hypertension

• Laboratory testing, such as blood tests
• Chest X-ray to look for signs of lung disease, an enlarged right ventricle or enlarged pulmonary arteries
• Heart ultrasound (echocardiogram or echo) to estimate pressure in the right heart, see heart function and evaluate for any other heart abnormalities
• Electrocardiogram (EKG) to measure your heart’s electrical activity
• Cardiac catheterization to directly measure pressure in the right heart and main pulmonary arteries

Tests to determine the group of pulmonary hypertension

There are several groups of pulmonary hypertension, depending on the cause. Each group has different treatments. To plan your treatment, you may have additional testing, which may include:

• Computerized tomography (CT) scan to see the size of your heart and look for signs of lung disease
• CT angiogram using a contrast dye to highlight blood vessels and look for blood clots or signs of lung disease
• Magnetic resonance imaging (MRI) to look at your heart’s structure and function in more detail
• Pulmonary function test to measure your lungs’ capacity, airflow and ability to exchange oxygen
• Sleep tests (polysomnogram) to help diagnose sleep apnea, which can contribute to pulmonary arterial hypertension
• Ventilation/perfusion (V/Q) scan, a type of lung scan to look for blood clots

Pulmonary hypertension treatment

Your treatment will help manage your pulmonary hypertension symptom and slow the condition’s progress. A precise diagnosis guides our treatment planning. We’ll treat the underlying causes of the disease, coordinating your care with other specialists as necessary.

We work closely with you to determine the best treatment options for you, based on the pulmonary hypertension group and your overall health needs. We monitor you closely to check your progress and may adjust your medications as necessary to minimize side effects and continue to improve your health.

Medications for pulmonary hypertension

You might receive medications by mouth, by inhalation or through a vein (intravenous). These medications include:

• Vasodilators that relax and widen your blood vessels to reduce blood pressure
• Diuretics, also called water pills, to remove excess fluid from your body
• Anticoagulants that thin your blood to prevent blood clots
• Antiarrhythmics, which control heart rate and help your heart beat more efficiently

Nonsurgical pulmonary hypertension treatments

Oxygen therapy, with an oxygen tank, can help you breathe easier and relieve fatigue and shortness of breath if your oxygen levels are too low.

We may also recommend healthy lifestyle habits such as:

• Heart-healthy diet: Eating nutritious foods with lower sodium helps reduce blood pressure and prevent swelling and fluid retention.
• Physical activity: Engaging in moderate exercise helps you improve fitness and maintain a healthy weight. It’s important that an exercise plan is approved by your doctor.
• Physical therapy and rehabilitation: Attending pulmonary rehabilitation treatments teaches you exercises to help improve your strength, mobility and fitness, and make it easier to breathe.
• Smoking cessation: Quitting smoking helps improve your breathing and overall health.
• Stress reduction: Using meditation and other relaxation techniques.

Surgery for pulmonary hypertension

If medications aren’t enough to manage your pulmonary hypertension, our cardiologists may recommend surgery. Pulmonary thromboendarterectomy is an open-heart surgery to remove old blood clots in the lungs, which can be the cause of pulmonary hypertension if you’ve had prior blood clots.

Research and clinical trials for pulmonary hypertension

There’s no known cure for pulmonary hypertension. However, our specialists conduct and participate in clinical trials and cardiovascular research to advance the standard of care. That’s why we can offer you the latest pulmonary hypertension treatments before they’re widely available.

We’re always involved in clinical trials for medications for pulmonary hypertension management. We’re constantly looking at innovative new therapies and devices to treat this condition.