Expert Advice: What makes pulmonary hypertension dangerous?
Host Amber Smith: Here's some expert advice from Dr. Krithika Ramachandran from Upstate Medical University. What makes pulmonary hypertension dangerous?
Krithika Ramachandran, MBBS: Pulmonary hypertension is dangerous because it causes you to have congestive heart failure, so the end result of untreated pulmonary hypertension, just like the end result of untreated systemic hypertension, is that you end up with these big dilated heart chambers, which are unable to push blood forward through the lungs anymore.
So now you have lack of blood flow forward, blood flow to the rest of the body, because the left side has inadequate blood to send forward. So you have low oxygen everywhere. Your brain is not getting perfused (properly supplied with blood), your kidneys are not getting perfused. So you can actually end up with congestive heart failure, and terminally with cardiogenic shock, which is when, essentially, all your organs are shutting down.
Anemia can worsen pulmonary hypertension because you have low blood counts, right? And there are fewer red blood cells to carry oxygen everywhere, but pulmonary hypertension and congestive heart failure, because of the chronic inflammation they set up, can cause anemia also. So, it's almost like this vicious cycle. In recent years, they've been screening patients for anemia and iron deficiency, and it's been shown that patients who are iron deficient actually have a higher chance of having bad outcomes from pulmonary hypertension or even from regular congestive heart failure.
So, we look to see if they are iron deficient, and we can actually supplement them, which improves their functional status, and it also helps improve their disease and their overall mortality.
The landscape for treating this disease has changed dramatically In the last, I would say, 10 to 15 years. Earlier, and by earlier I mean maybe back in the early '90s, late '90s, it was almost like a death sentence. If you were diagnosed with it, more than 50% of patients were dead before three years were out. But now, it can be one of those diseases that you kind of die with instead of die from.
So there are multiple medicines now which help dilate these blood vessels in the lungs and bring the pressure down so that the right side of the heart feels less stress while pumping blood through the lungs. So definitely there are multiple, multiple treatments now, as compared to a few years ago, which has changed the outlook of the disease.
Host Amber Smith: You've been listening to Dr. Krithika Ramachandran from critical care and pulmonology at Upstate Medical University.