105 ~ The Right Heart ~

November is a multiple disease awareness month but today we focus on

Pulmonary Arterial Hypertension

PAH is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart.

When these arteries become narrowed, blocked or destroyed, it becomes harder for blood to flow through the lungs, and raises pressure within the lungs’ arteries.

As pressure builds, the heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing the heart muscle to weaken and fail.

Symptoms of PH can be mistaken for other diseases such as asthma or chronic obstructive pulmonary disease (COPD).

People for whom it is suspected, should get a diagnosis from a PH specialist.

It is also important to know that not all are the same, there are 5 different groups based on different causes.

In SA – Gauteng specifically, major awareness regarding diagnostic methodologies are required.

If you’re on par with posts, remember PH appeared as a surprised, suspected disease since January 2018, again in June, then in October.

Some are confused where does the suspicion of it coexist in my case so just thought I’ll clarify a little more:

It seems to be most likely from Left Sided Heart Failure that in turn causes Pulmonary Edema, both then effecting lung pressure & the right side of the heart.

“If Pulmonary Edema continues (chronic), it can raise pressure in the pulmonary artery (pulmonary hypertension), and eventually the right ventricle of the heart becomes weak and begins to fail.

The right ventricle has a much thinner wall of muscle than does the left side of your heart because it is under less pressure to pump blood into the lungs.

The increased pressure backs up into the right atrium (upper chamber) and then into various parts of your body, where it causes swelling etc”

Leaving aside my other conditions, here I set arrows to illustrate how the interlinked cardiac & lung conditions began.

Dysautonomia ➡️ Mitral Valve Prolapse ➡️ Coronary Artery Spasms (Prinzmetals Angina) ➡️ Tachycardia ➡️ Pulmonary Edema ➡️ Adult Respiratory Distress Syndrome ➡️ Suspected Pulmonary Hypertension ➡️ Right Ventricular Strain ➡️ Right Bundle Brunch Block…

Here are the 3 links where i elaborated so most readers should be fimilar with the terms

https://kayborninmay.wordpress.com/2018/01/16/21-lifes-wildest-journeys/

https://kayborninmay.wordpress.com/2018/06/03/63-two-culprits-caught/

https://kayborninmay.wordpress.com/2018/10/18/101-an-ocean-connotation/

In the explanations below I’ve ticked the tests that were performed on me, some need to be repeated & a few need to be conducted.

SYMPTOMS

In its early stages might not be noticeable for months or even years. As the disease progresses, symptoms worsen.

Shortness of breath (dyspnea), initially while exercising and eventually while at rest

⚠️Fatigue

⚠️Dizziness or fainting spells (syncope)

⚠️Chest pressure or pain (angina)

⚠️Bluish color to your lips and skin (cyanosis)

⚠️Racing pulse or heart palpitations

⚠️Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites)

DIAGNOSIS

Is hard to get early because it’s not often detected in a routine physical exam. Even when the condition advances, signs and symptoms are similar to other heart and lung conditions.

A doctor will review your medical and family history, discuss signs and symptoms, and conduct a physical examination.

Several tests will be ordered to confirm & determine the severity of the condition and find out the (etiology) cause of your condition.

PH can either be primary or secondary.

10 TESTS LISTED

1) Electrocardiogram (ECG / EKG):

A noninvasive test that shows the heart’s electrical patterns and can detect abnormal rhythms.

Doctors may also be able to see signs of Right Ventricular Strain (enlargement)

☑️ Two right heart abnormalities were detected & discussed, including RVS.

2) Echocardiogram (ECHO):

☑️ I’ve had 3 basic ones conducted & explained in great length regarding echo test types & findings.

Forgotten to include this part previously:

An echo creates sound waves & moving images of the heart. It can help to check the size and functioning of the right ventricle, and the thickness of the right ventricle’s wall.

It also shows how well heart chambers and valves are working.

– Discussed in chapter 18.

It may also be used to measure pressure in the pulmonary arteries but keep in mind – the facts mentioned in the previous post ⚠️

In certain instances, a doctor should recommend an exercise echocardiogram to help determine how well your heart and lungs work under stress.

In this test, you’ll have an echocardiogram before exercising on a stationary bike or treadmill and another test immediately afterward.

This could be done as an oxygen consumption test, in which you may have to wear a mask that assesses the ability of your heart and lungs to deal with oxygen and carbon dioxide.

❎ Haven’t done this type.

3) Chest X-ray (CXR):

Shows images of the heart, lungs and chest. Enlargement of the right ventricle of the heart or the pulmonary arteries, which can occur in PH.

☑️ 3 were conducted & discussed.

4) Pulmonary function test (PFT):

This noninvasive test measures how much air the lungs can hold, as well as the airflow in and out of the lungs. During the test, you’ll blow into a simple instrument called a spirometer

☑️ 3 conducted & discussed.

5) Right heart catheterization (RHC) – The golden test:

Helps to confirm PH and determine the severity of a condition.

In fact, it was a test highly recommended to me by another PH lady in Los Angeles who said after all tests were performed, a right heart cath finally proved hers.

During the procedure, a cardiologist imserts a thin, flexible tube (catheter) into a vein in the neck or groin.

The catheter is then threaded into the right ventricle and pulmonary artery.

Right heart cath allows a doctor to directly measure the pressure in the main pulmonary arteries and right ventricle.

It’s also used to see what effect different medications may have on a person’s PH.

❎ Not yet conducted.

6) Blood tests:

Blood tests to check for certain substances in the blood that might show PH, its complications & cause.

❎ Not taken.

Additional tests in order to check the condition of lungs and pulmonary arteries include:

7) Computerized tomography (CT) scan:

During a CT scan, you lie on a table inside a doughnut-shaped machine. CT scanning generates X-rays to produce cross-sectional images of your body.

Doctors may inject a dye into the blood vessels that helps the arteries to be more visible on the CT pictures

Also to look at the heart’s size, function and check for blood clots in the lungs’ arteries.

☑️ 1 conducted 17 months ago.

8) Magnetic resonance imaging (MRI):

This test may be used to check the right ventricle’s function and the blood flow in the lung’s arteries.

In this test, you lie on a movable table that slides into the tunnel.

An MRI uses a magnetic field and pulses of radio wave energy to make pictures of the body.

❎ Not conducted.

9) Polysomnogram:

This test detects your brain activity, heart rate, blood pressure, oxygen levels and other factors while you sleep. It can help diagnose a sleep disorder such as obstructive sleep apnea (OSA)

❎ Not conducted.

10) Ventilation/perfusion (V/Q) scan:

In this test, a tracer is injected into a vein in the arm.,The tracer maps blood flow and air to your lungs.

It can be used to determine whether blood clots are causing symptoms of PH.

❎ Not conducted.

PH HAS 4 CLASSIFICATIONS

1) Although diagnosed, no symptoms are experienced with normal activity.

2) Asymptomatic at rest, but symptoms such as fatigue, shortness of breath or chest pain are experienced with normal activity.

3) Comfortable at rest, but experience symptoms when physically active.

4) Symptoms with physical activity and while at rest.

TREATMENT MANAGEMENT

➖ Medication types differ between adults & kids. The FDA has approved only 1 for kids & 14 for adults – to manage the different symptoms.

➖ Pulmonary Rehab centre’s that structure programs according to a condition.

➖ Life saving procedures such as transplant.

➖ YouTube blogger ChloesPHriend posts beneficial information for adults living with PH, as she is, & how you can’t cure but improve symptoms for the better.

✖️ It is not advisable for people with PH to carry heavy items.

✖️ Also not advisable to go up into high altitudes. Some patients who live at high altitude regions are told to come down lower.

PROGNOSIS (LIFE EXPECTANCY)

Also differs based on a known / unknown etiology.

In reference to the etiology (root cause) of a disease being unknown, it is termed as idiopathic.
Some forms are serious conditions that become progressively worse and are sometimes fatal.

Although some forms of pulmonary hypertension aren’t curable, treatment can help lessen symptoms and improve quality of life.