Once you've received a diagnosis of pulmonary hypertension, your doctor may classify the disease.
- Class 1. Although you've been diagnosed with pulmonary hypertension, you have no symptoms.
- Class 2. You don't have symptoms at rest, but you experience fatigue, shortness of breath or chest pain with normal activity.
- Class 3. You're comfortable at rest but have symptoms with slight exertion.
- Class 4. You have symptoms even at rest.
Pulmonary hypertension can lead to a number of complications, including:
- Enlarged right ventricle (cor pulmonale). In this condition, your heart's right ventricle becomes enlarged and eventually fails. It occurs when the right ventricle — which is less muscular than the left ventricle — has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries. Initially, the heart tries to compensate by thickening its walls and dilating the chamber of the right ventricle to increase the amount of blood it can hold. But this measure works only temporarily, and eventually the right ventricle fails from the extra strain.
- Blood clots. These are plugs of platelets — the colorless blood cells that repair injured blood vessels — enmeshed in a network of protein (fibrin) and red blood cells. Clots are the end result of a complex process that helps stop bleeding after you've been injured. But sometimes clots form where they're not needed. Having pulmonary hypertension makes it more likely you'll develop clots in the small arteries in your lungs, further aggravating narrowed or blocked blood vessels.
- Fluid in the lungs (pulmonary edema). This potentially life-threatening condition occurs when increased pressure in the veins and capillaries in your lungs forces fluid out of the capillaries and into the lungs' air sacs, filling your lungs with fluid. This makes it difficult for your lungs to supply your body with oxygen and to eliminate carbon dioxide.
Doctors need considerable skill to find the optimal treatment for each person with pulmonary hypertension. 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, the type and class of pulmonary hypertension, and your 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
- Endothelin receptor antagonists
- High-dose calcium channel blockers
- Anticoagulants .
- 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 some 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.
Although medical treatment can't cure pulmonary hypertension, it can lessen symptoms. You can also help improve the quality of your life by following these health measures:
Find ways to reduce stress. These can range from yoga , meditation and biofeedback to warm baths, music or a good book. Try to allow at least 30 minutes a day for an activity you find relaxing. Many people with pulmonary hypertension find that simply reducing stress can greatly improve the quality of their lives
- Get plenty of rest. Getting ample rest can help combat the fatigue that may accompany pulmonary hypertension.
- Follow a nutritious diet and maintain a healthy weight. Emphasize lean chicken, fish, whole grains, and fresh fruits and vegetables. For the health of your heart, limit your intake of all types of fats to no more than 30 percent of your daily calories. Limit animal (saturated) and trans fats (hydrogenated oils) to 10 percent or less.
- Don't smoke. If you smoke, the single most important thing you can do for your heart and lung health is to stop. If you can't stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit. Researchers don't yet know whether secondhand smoke — also known as passive or environmental smoke — plays a role in pulmonary hypertension. It is known, however, that exposure to environmental smoke can lead to a number of other health problems, including lung cancer and heart attack.
- Stay as active as possible. Even the mildest forms of activity may be too exhausting for some people with pulmonary hypertension. For others, moderate exercise such as walking may be of great benefit, and using oxygen during exercise may be especially helpful. Your doctor can help you plan an appropriate exercise program.
- Avoid becoming pregnant or using birth control pills. If you're a woman of childbearing age, avoid becoming pregnant. Pregnancy can be life-threatening for both you and your baby. Also avoid using birth control pills, which can increase your risk of blood clots. Talk to your doctor about alternative forms of birth control.
- Avoid traveling to or living at high altitudes. High altitudes can aggravate the symptoms of pulmonary hypertension. If you live at a high altitude, your doctor may advise you to move to a lower elevation.