Pulmonary Arterial Hypertension : Heart Disease :Tests & Treatment

The pulmonary arteries carry blood from the heart to the lungs. PAH increases the resistance of blood flow through the lungs. Due to the increased strain the right side of the heart pumps blood less effectively, this can eventually lead to heart failure, known as right ventricular failure.

Pulmonary arterial hypertension (PAH) is defined as mean pulmonary arterial pressure >25mm Hg at rest and >30mm Hg on exertion. Symptoms and Signs of PAH generally do not appear until the right side of the heart begins to fail. The causes are many and its diagnosis is done by Echocardiography (ECHO) and other tests if necessary. For mild to moderate cases treatment is medication but more severe cases may need lung transplantation.

Diagnosis

The Echocardiogram (ECHO -ultrasound of the heart) measures size and shape of the heart, assess the functioning of the heart chambers and valves

(a) Right heart catheterization- a catheter is inserted through the femoral vein/subclavian vein advancing it to the right ventricle. This catheter is connected to a device to monitor the arterial pressure.
(b) Electrocardiogram (ECG)
(c ) Chest X-ray (may show enlargement of the right ventricle)
(d) MRI
(e) PET (positron emission tomography)- shows the level of the chemical activity of the heart

Treatment

Medication :

  • Anticoagulant medicines- warfarin
  • Calcium channel blockers- relaxes the blood vessels and increases blood and oxygen supply to the heart
  • Epoprostenol- widens the arteries of the lungs and thus prevents formation of clots. It is given intravenously
  • Iloprost- patients are nebulized with this medicine. It reaches the lungs directly and prevents formation of clots.
  • Treprostinil- relaxes vessels and increases blood supply to the lungs
  • Bosentan- widens arteries of the lung and reduces blood pressure
  • Nitric oxide inhalation- widens arteries of the lung and reduces blood pressure
  • Diuretics
  • Sildenafil

The treatment sometimes involves Oxygen Treatment and in extreme cases Lung Transplantation is resorted to.

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