Known as the “cancer of cardiovascular diseases,” pulmonary hypertension (PAH) requires long-term treatment and is stressful both physically and financially. Last year, patients with pulmonary hypertension were excited by the news that a targeted drug for pulmonary hypertension was being added to medicare.
“Cancer in cardiovascular disease” sounds scary. Who is prone to pulmonary hypertension? Can it be saved? How to do early detection and early treatment? Let’s hear more from the director of the Academy of Medical Sciences.
Q: I’ve never heard of pulmonary hypertension. Is it a rare disease?
A: It is not appropriate to say that pulmonary hypertension is A rare disease. What is pulmonary hypertension? At sea level, at rest, we put a catheter in the pulmonary artery and measure the pulmonary artery pressure, and as long as the average pulmonary artery pressure is 25 millimeters of mercury or more, we say that the person has pulmonary hypertension. Therefore, pulmonary hypertension is an abnormal hemodynamic condition and is not an independent disease. Clinically, the most common pulmonary hypertension is caused by diseases of the left heart system and lung disease. We often refer to pulmonary hypertension as a rare disease, but actually it’s mainly idiopathic pulmonary hypertension. In general, the presence of PULMONARY hypertension often indicates that the underlying disease has advanced to a more serious level. At present, awareness and awareness of PULMONARY hypertension are insufficient, and high attention is needed.
Q: What causes pulmonary hypertension? How is it treated?
A: Clinically pulmonary hypertension can be divided into five categories: 1. Arterial pulmonary hypertension; 2. 2. Pulmonary hypertension associated with left heart disease; 3. Pulmonary disease/hypoxic pulmonary hypertension; 4. Pulmonary obstructive pulmonary hypertension; 5. Pulmonary hypertension of unknown cause or multiple mechanisms.
Different types of PULMONARY hypertension have different therapeutic strategies. Arterial HYPERTENSION and some patients with chronic thromboembolic hypertension can benefit from targeted drugs, so how to define arterial hypertension is important. Arterial hypertension includes idiopathic pulmonary hypertension, hereditary pulmonary hypertension, drug and toxicant hypertension, congenital heart disease hypertension, and connective tissue disease hypertension. If such patients can achieve early detection and diagnosis, standard use of targeted drugs, and regular review, generally good results can be achieved. Unfortunately, many patients with PULMONARY hypertension are found too late, or medication is not used in a timely and standardized way, so that the disease is delayed.
The use of targeted drugs suggests early, combined (initial/sequential), and targeted (maintained at low risk) therapy. In the past, due to the influence of economy, the vast majority of patients could not achieve the combination of drugs.
Pulmonary hypertension associated with left heart disease, such as hypertension, coronary heart disease, valvular heart disease and other causes of left heart dysfunction caused by pulmonary hypertension cannot benefit from targeted drugs, and may even aggravate heart failure, exacerbating the disease. The third lung disease/hypoxic pulmonary hypertension should be actively treated to improve the hypoxic condition. In patients with CHRONIC obstructive pulmonary disease, targeted drugs given without addressing airway patentation and hypoxia may aggravate hypoxia and worsen the condition. Therefore, when we suspect that a person has PAH, we need to first identify it and determine what type of PAH it is, what nature of PAH it is, and to what extent it has developed so that we can develop individualized treatment strategies.
Q: Who is more susceptible to pulmonary hypertension? Do women have higher hair? Is it related to age?
A: Generally speaking, people with heart and lung diseases are more likely to develop pulmonary hypertension. Once pulmonary hypertension occurs, it means that the original underlying disease has been more serious. Pulmonary hypertension is not an independent disease, so there is no data showing that women are more likely to develop PAH. However, rheumatoid autoimmune disease, one of the multiple underlying diseases of PAH, is more likely to occur in young women. In the past, idiopathic PULMONARY hypertension was thought to be more common in young women, but recent data show that the differences between age and sex in patients with idiopathic pulmonary hypertension are becoming smaller.
Q: Are women with this disease infertile? How much does it affect women?
A: Pregnancy and childbirth can be disastrous for patients with pulmonary hypertension due to hemodynamic changes during pregnancy. The risk of death during pregnancy with PULMONARY hypertension is 30% to 50%, which is very high. Thirty-two to thirty-four weeks of gestation, childbirth and three days after delivery are the most obvious periods of blood volume and hemodynamic changes in pregnant women. These three periods are the most dangerous periods of heart failure, severe arrhythmia, pulmonary hypertension crisis and sudden death in pregnant women with pulmonary hypertension. Patients with pulmonary hypertension have hypoxemia during pregnancy, will affect fetal growth and development, and even lead to fetal distress and neonatal asphyxia. Therefore, in patients with pulmonary hypertension, especially those with signs of right heart dysfunction, pregnancy is not recommended. In the course of treatment, pregnancy should be avoided more. If pregnancy is not careful, pregnancy is within 3 months, and termination of pregnancy is recommended.
But you can’t generalize. If the pregnancy is more than 3 months, especially in the middle and late stages, the body has no reaction, and the right heart function tends to be normal, it is not recommended to precipitarily induce labor, because labor induction and labor are the same process, with similar risks. What we need to do is step up the treatment of PULMONARY hypertension and bring together multidisciplinary teams to help pregnant women get through this. Close clinical monitoring should be paid attention to, including monthly clinical follow-up in the first and second trimester and weekly clinical follow-up in the third trimester.
In a word, according to the severity of the disease, pregnancy time stage, personalized treatment of pulmonary hypertension pregnant women, not one size fits all. Successful management of pregnant women with PULMONARY hypertension requires a multidisciplinary team that includes professionals from obstetrics, anesthesiology and neonatology, as well as pulmonary hypertension specialists and experienced caregivers working together. Individualized management is advocated according to maternal pulmonary hypertension risk stratification, pregnancy period, and complications.
Q: Are there early symptoms of pulmonary hypertension? How to detect early early treatment?
A: after the occurrence of pulmonary hypertension in patients with fatigue, activity felt shortness of breath, these symptoms are gradually increasing, usually early in the resting state there is no discomfort, especially curtilage at home, and movement seldom, if you are unwell, resting state that disease has reached A serious level, is, in fact, delay the disease. For pulmonary hypertension at high risk, therefore, must be regularly, closely observe the condition changes, once appeared in the process of treatment of underlying diseases with a disease can not explain the basis of fatigue, shortness of breath, activity, etc., will be careful whether pulmonary hypertension, pulmonary hypertension screening when necessary, clear the diagnosis of pulmonary hypertension, so as to achieve early detection, early treatment.
Q: What should patients or their families pay attention to once they have pulmonary hypertension?
A: The family should first take good care of the patient, supervise the patient to take medicine regularly as prescribed by the doctor, and review the patient regularly. Improper excessive activity is easy to cause syncope, daily life must pay attention to. We had a patient who, in the middle of treatment to see how he was doing, ran up the stairs and passed out. In another, the phone rang in the middle of the night, causing a startled patient to get up. The rapid change in position caused his heart to beat faster and his left heart to get smaller, causing him to faint. Inappropriate exercise aggravates the condition and even leads to syncope, so some patients simply do not move. We say inappropriate exercise can be dangerous, but we should not exercise, but do what is right for you, and gradually increase the amount of exercise. In addition, the patient should not have a particularly large mood fluctuations, when angry pulmonary artery pressure will rise, is also fatal. Even dry stools need to be managed, because stools exert themselves to increase abdominal pressure, which can also lead to increased pulmonary artery pressure and increase the burden on the heart.
Family members should do a good job in the patient’s psychological counseling, spiritual support. Due to physical discomfort and the economic burden brought by medical treatment, patients will have great pressure in their heart. Sometimes, a look or an impatient move from their families will aggravate their illness.
For patients with pulmonary hypertension, eating and drinking water should also be paid attention to, and drinking water should be strictly controlled in patients with existing right heart failure. Patients with pulmonary hypertension and heart failure may particularly want to drink water, but due to high pulmonary vascular resistance and enlarged right heart, they cannot tolerate taking in large amounts of water for a short period of time. This will make right heart failure worse. Therefore, family members should help them control the amount and keep their mouth shut. Also, keep warm to prevent colds.
We recommend that patients take a 6-minute walk distance self-test in the company of family members at home to see if their activity endurance is improving. Once the condition is found to worsen, or not good, it is necessary to timely seek medical treatment, adjust the medication. In conclusion, active, standardized and effective treatment is recommended for patients with PULMONARY hypertension to achieve and maintain a low risk state, so as to improve the quality of life and return to normal life as soon as possible.