- [Voiceover] Talking about the treatment
of pulmonary hypertension can be a little complicated
just because it can be caused by so many other things.
And in fact, our diagnosis is not over
just having found with the catheter
that the pressure's elevated in the pulmonary artery.
The workup is usually huge and extensive
to find out why we have pulmonary hypertension.
So our treatment really goes off of that.
So you have to treat the underlying cause.
And that really is the theme of this whole treatment video,
is that we have to treat the underlying,
whatever it is, that's causing the pulmonary hypertension
in the first place, treat the underlying cause, okay.
So intuitively, we go to the lungs first.
Pulmonary hypertension, what can happen
in the lungs that lead to it.
If we have asthma or COPD or chronic bronchitis,
whatever it is, we'll try to reverse the underlying disease.
So we might give patients drugs
to decrease the hypoxia or the lack of oxygen,
the lack of good ventilation in the lungs,
so help with our pulmonary hypertension.
And like I promised before,
I'll always mention in the lung videos
that we have to stop smoking.
Smoking itself can lead to pulmonary hypertension,
not to mention the other things, like cancer
or obstructive diseases that can happen in the lungs.
Sometimes if we do the workup and we can't find out
why we have pulmonary hypertension,
we call it idiopathic or that it just over rises on its own.
In this case we might give patients
what's called endothelin antagonists.
So endothelin is literally the chemical
that's released by the lung tissue
to restrict the pulmonary vasculature.
And sometimes that's necessary and it's good for us.
But an overproduction would give us
pathologic pulmonary hypertension.
And we want to give agonists or, I'm sorry, antagonists
to stop that process.
So this is going straight to the source.
But we usually don't want to go there
unless we can rule out other treatable causes
of pulmonary hypertension in the lungs.
So going outside the lungs,
we're really entering a huge pool of possibilities
of things that can cause our condition.
In general, if we have our heart and lungs like this
and we think about the ways in which they're connected,
it's the right side of the heart
that pumps blood to the lungs,
and then it's the left side that it is returned to.
I'm not going to worry about which chamber right now.
But just think of the sidedness of it, right and left.
So to treat problems on the right side...
by the way, we're treating the symptoms
as well as the causes.
So a lot of symptoms on the right side
is over volume, overloading of fluid.
So we might give diuretics
to have them pee out some of this extra volume,
just decrease the blood volume,
which will make them feel better symptoms-wise.
So we have less congestion going back there.
We might do something called a beta blocker
which decreases the heart rate, beta blocker.
It plays on the beta receptors in the heart.
And it decreases the rate,
gives the right side a chance,
give it some extra time to fill the lungs,
decrease some of the workload on the heart
so that it's not pushing against a wall so hard.
These same treatments could help the left side of the heart.
Left side, remember, can cause pulmonary hypertension
because it's not pumping out blood
to the body like it's supposed to
and it backs up into the lungs.
So diuretics and beta blockers can help that too
by decreasing the workload,
giving this dysfunctional left heart
a better chance to do its job.
But we can also give drugs
that give the left side a little bit of a kick.
So there's a whole big class of drugs
called the inotropes or ionotropic drugs
that bank the heart work harder
so we can increase the motor power behind the left side,
make it push out harder
so we have less backup in the lungs
and can alleviate the pulmonary hypertension
or if we have a valve issue on the left side
that's causing this ineffectiveness,
we could repair the mitral valve
because mitral valve dysfunction
can lead to decreased left side work
which leads to backup into lungs.
And then sometimes we can give people anticoagulate.
And then sometimes we can give people anticoagulants
because one thing that could cause
really bad hypertension in the lungs
is if you have little blood clots.
A big blood clot in the lungs would kill you.
But if you have lots of little ones,
they're not enough to kill ya,
but it would definitely create a lot of hypertension
and blockage in the vasculature.
So anticoagulation could be for people
who are prone to make these blood clots.
Coagulation.
And then of course you want to investigate
why they're prone to coagulation
in the first place and treat that.
So our general idea, again,
is just to show you that
it literally could be anywhere in the body.
The problem could be in the liver.
It could be in the feet.
But the point is that we always come back to treating
what we can treating the underlying cause.
And a lot of times we're dealing with symptoms
rather than causes because the cause can be hard to treat
or it's global or we're dealing with a side effect
of a drug that's necessary to treat something else.
So it's a little bit of a balance act.
And sometimes we might need to get really drastic.
And then the heart, surgically we can sometimes
cut a hole between the top chambers,
the right and left atria.
The procedure of cutting this hole is called a septostomy.
So sept for the septum and the wall between them.
And ostomy is a hole.
All this does is alleviate some of that
buildup pressure on the right side.
So if we have a lot of backup in the right side,
it's causing right heart failure
and congestion and swelling,
then cutting this hole allows some of it
to go to the left side,
which will lower the oxygen content in the left side.
But we are willing to sacrifice that
to equalize the pressure a little bit
and alleviate some of this right heart failure symptoms.
And surgically, if we do get a lot of clots
that we can't take care of with anticoagulation,
there's an option to go in
and physically remove the clots surgically.
And of course, you can't do this every week.
This is kind of drastic.
But if we think the culprit are these blood clots,
then we can remove them and prevent them
from coming back with drugs,
then sometimes it's worth doing.
And then at the end of the day
we always have transplant as an option
if all other therapies fail
or we think we can switch out the lungs
and prevent the same thing from happening,
then we can always go to transplant as a last resort
and give this person a new set of lungs.
So pulmonary hypertension,
very complicated to treat.
And the treatment depends largely
on a good workup to find the underlying causes
and playing with the drugs to control our symptoms
and reverse the cause.