goals | questions | causes | tests & medication
Goals
- Provide timely, complete and accurate diagnostic evaluation to all patients with suspected pulmonary hypertension
- Offer patients a complete explanation of their disease process, options for treatment, and prognosis.
- Provide each patient with a comprehensive treatment program
- Improve hemodynamics, longevity and quality of life with treatment
- Delay / avoid transplantation
- Support each patient throughout evaluation, treatment and follow-up
- Maintain communication with referring physicians at all times.
Members of the Service:
Paul Fairman, MD
Dan Grinnan, MD
Janet Pinson, RNC, ACNP
Julia Watson, RN
Laura Savage, RN, MSN
George Vetrovec, MD
William Moskowitz, MD
Amy Frayser, Research Coordinator
The Pulmonary Hypertension team welcomes new patients in the Clinical Research Center, 8th floor in the North Hospital.
The patients may use valet parking at the Massey Cancer center for that visit.
Pulmonary Hypertension Questions
What is pulmonary hypertension?
Pulmonary hypertension is high blood pressure in the lungs. More specifically, it’s high blood pressure in the blood vessels (pulmonary arteries) that carry blood from the right side of the heart to the lungs. The pressure in these blood vessels is not the same as the pressure measured by a cuff wrapped around your arm, and a measurement of the blood pressure in your arm gives no information about the blood pressure in your pulmonary arteries.
Under normal circumstances, pulmonary artery blood pressure is much lower (20/10) than blood pressure in measured in your arm (120/75). By the time pulmonary hypertension is discovered, pulmonary artery pressures are often three times normal (60/30).
Why is pulmonary artery hypertension a problem?
As pressure rises in the pulmonary arteries, the heart must work harder to pump blood through the narrowed pulmonary vessels. This stresses the heart. It becomes enlarged and less able to pump blood through the lungs and out to the rest of the body. Many of the symptoms of pulmonary hypertension are caused by the heart’s limited capacity to pump blood in normal amounts.
What causes pulmonary hypertension?
There is no single answer. There are several causes of pulmonary hypertension. Each person deserves a complete medical evaluation to discover the cause of her or his pulmonary hypertension. Disorders of the lungs, heart, liver and collagen vascular system can cause pulmonary hypertension. In some patients, no cause can be identified Causes of Pulmonary Hypertension - follow the link.
In most patients pulmonary hypertension begins when the blood vessels carrying blood into the lungs constrict, narrowing the channel for flowing blood. Over months and years, the blood vessel lining becomes thicker, restricting the flow of blood further. These changes force the pressure within the vessels to increase.
What are the symptoms of pulmonary artery hypertension?
- Fatigue; feeling tired all the time
- Shortness of breath, especially with activity
Shortness of breath is the most common symptom and the one that most frequently forces patients to seek help. Almost every patient has difficulty with fatigue and shortness of breath. These symptoms are not unique to pulmonary hypertension; other heart and lung problems might cause similar symptoms. A thorough evaluation is necessary to evaluate these symptoms and identify the cause if pulmonary hypertension is discovered. Other pulmonary hypertension symptoms are less common and include:
- Swollen feet and ankles
- Dizziness with activity or standing suddenly
- Chest pain during activity
- Fainting
What tests are needed to evaluate pulmonary artery hypertension?
Every patient with pulmonary hypertension deserves a complete evaluation. Most patients will need to complete a majority of these tests, and some patients may need additional testing.
What can be done to treat pulmonary artery hypertension?
More than ever before, pulmonary hypertension is treatable. Each patient deserves a treatment plan designed for the specifics of his or her disease. Not all patients are treated with the same medication(s). Some possible treatments are:
- Warfarin , an anticoagulant, to prevent clotting in pulmonary arteries
- Oxygen, if oxygen levels are low
- Diuretics (fluid pills) to reduce excess fluid in the body
- Digoxin to improve heart pumping
Three other medications, sometimes referred to as “vasodilators”, can also be used. Each seems to work by dilating or opening up narrowed blood vessels.
- Calcium channel blockers (diltiazem, nifedipine and others) have been used the longest in treating pulmonary hypertension, but few patients respond to these drugs.
- Prostacyclin drugs (epoprostenol, treprostinil) require continuous (24 hours a day, 7 days a week) infusion through a catheter, or frequent (6-9 times daily) inhalation from a nebulizer.
- Endothelin receptor antagonists are oral medications for the treatment for pulmonary hypertension. Bosentan is the only one available currently, but two others are in development.
- Phosphodiesterse 5 inhibitors are also available for oral administration. Sildenafil is the only approved medication in this category, but another is being tested.
Research is developing new therapies. New medications are on the horizon.
For patients who do not respond to treatment, lung transplantation may be a consideration.
What will happen to me?
Pulmonary hypertension is a chronic problem. If you have pulmonary hypertension you should expect that you would need treatment for the rest of your life.
Pulmonary hypertension is a serious problem: it is likely to cause symptoms, limit physical capabilities, and may cause disability and shorten life.
The good news is that treatment for pulmonary hypertension now is better than ever. Warfarin, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors and prostacyclin analogues have all been shown to improve symptoms and some prolong survival. More options should be available soon. Cure is not possible in the foreseeable future, but improved quality of life and a longer life span are within reach.
Where can I get help?
The Pulmonary Hypertension team welcomes new patients in the Clinical Research Center, 8th floor in the North Hospital.
The patients may use valet parking at the Massey Cancer center for that visit.
You can contact the VCU Pulmonary Hypertension Service. We can help you with information, support, appointments and treatment.
- e-mail: PAH@vcu.edu
- Phone: 804-828-9071
- Mail: 1200 E. Broad St, Box 980050, Richmond, VA 23298-0050
The follow-up appointments are in two locations the Ambulatory Care Center - 4 and the Stony Point facility.
Additional information and help are available from the following:
goals | questions | causes | tests & medication |
