Pulmonary Hypertension: What you need to know

Aug 24, 2023

Pulmonary Hypertension: What you need to know

Learn about pulmonary hypertension risk factors, signs, symptoms, and the importance of not delaying care with Dr. Mrinalini Krishnan, advanced heart failure cardiologist.

Learn more about Dr. Kishnan: https://www.medstarhealth.org/doctor/…

Content

2.879 -> hello and welcome to another live

4.64 -> broadcast with medstar health my name is

7.2 -> karen single and i'm joined today by

9.44 -> advanced heart failure cardiologist dr

12.08 -> marin milani krishnan today we're

14.96 -> discussing pulmonary hypertension and

17.119 -> the importance of not delaying care

19.92 -> although pulmonary hypertension or ph is

23.439 -> rare it is a serious condition where the

26.16 -> blood vessels that carry blood from your

28.32 -> heart to your lungs becomes hard and

31.359 -> narrow causing your heart to work harder

34.079 -> to pump the blood through

35.84 -> so today we'll talk about risk factors

39.04 -> symptoms diagnosis and treatment for

42.239 -> pulmonary hypertension so thank you for

45.28 -> joining us today give us a like let us

48 -> know you're watching share this

49.76 -> broadcast with your friends and family

51.92 -> and ask your questions in the comments

54.399 -> dr krishnan welcome and thank you for

56.559 -> joining us thank you so much so as you

59.52 -> know i'm dr mirnalini krishnan i'm an

61.92 -> advanced heart failure and transplant

63.76 -> cardiologist at medstar and i specialize

66.799 -> in caring for patients with pulmonary

68.72 -> hypertension and i see them both here at

71.2 -> union memorial in baltimore as well as

73.6 -> at washington hospital center in dc

76.08 -> so i've actually been a part of the

77.759 -> medstar team for about two years now

80.159 -> including my heart failure training in

81.759 -> dc

82.96 -> and prior to which i was actually

85.119 -> at the university of alabama at

86.64 -> birmingham specifically training in

88.56 -> pulmonary hypertension and heart failure

92.479 -> i'm also the educational chair for

95.28 -> cardiology here at medstar in baltimore

97.84 -> so i'm very passionate about teaching

99.6 -> whether it's my patients whether it's

101.36 -> medical students or residents junior

103.68 -> doctors or really whoever wants to learn

107.2 -> so as you know karen this is my second

109.84 -> facebook live so for those of you that

111.92 -> tuned in back in february we spoke about

114.96 -> covid19 and heart failure and so today

118 -> i'm really excited to talk about

119.52 -> pulmonary hypertension so thank you so

121.52 -> much for having me

123.119 -> of course thank you so much for joining

125.28 -> us and thank you for telling our viewers

127.28 -> about yourself and we're glad to have

129.2 -> you back so let's get into some

131.44 -> questions we have about pulmonary

133.44 -> hypertension let's just start with what

135.76 -> is it and what causes it

137.84 -> absolutely so pulmonary hypertension is

140.48 -> a medical condition that affects the

142.56 -> arteries or the blood vessels in your

144.72 -> lungs so pulmonary meaning lung and

147.92 -> hypertension meaning high pressure so

150.319 -> just like patients who have hypertension

152.4 -> or high pressure

153.76 -> these patients specifically have high

155.84 -> blood pressures in their lung arteries

158.879 -> so the way we think about it is all the

160.72 -> blood in our body comes back to the

162.56 -> right side of the heart and then goes

164.4 -> into your lungs and your lung arteries

166.64 -> and then into your lungs where oxygen

168.879 -> and carbon dioxide get exchanged and

171.2 -> then that blood with oxygen then goes to

173.12 -> the left side of the heart and then gets

174.879 -> pushed out to your body again so it's

176.8 -> kind of like a hose if you pinch down at

179.44 -> a certain part of a hose then you get

181.04 -> back pressure behind that point so these

183.76 -> patients will get high pressures or

186.159 -> pinching down in their lung arteries

188.8 -> which can then cause stretching or

190.64 -> strain and even lead to the failing of

193.84 -> the right side of the heart as a result

195.84 -> of

197.84 -> thank you that makes a lot of sense and

199.36 -> thank you for that analogy that helps

201.12 -> helps me to and our viewers i'm sure to

203.44 -> understand what it is

205.36 -> um so what are the symptoms that

207.2 -> indicate someone might have pulmonary

209.2 -> hypertension

210.64 -> so pulmonary hypertension is a little

212.56 -> bit tricky in the sense that some of the

214.4 -> symptoms people have overlap with a lot

216.879 -> of other medical conditions so people

218.799 -> might have trouble breathing especially

221.2 -> when they try to do certain activities

224 -> or they might even have fatigue or

226.159 -> tiredness so a lot of people as they get

228.799 -> older kind of just chalk that up to

230.48 -> getting older and they're not really

232.08 -> sure

232.959 -> but their stamina isn't there the way

234.959 -> that it was before and their breathing

236.799 -> really limits them from what they're

238.4 -> able to do and they're not able to do

240.159 -> the things they were able to do before

241.92 -> three months six months or a year before

244.879 -> when it leads to the point of having

246.959 -> right-sided heart failure as a result of

249.84 -> those high pressures then people can

252.08 -> start having swelling in their belly or

254.56 -> in their legs and more trouble breathing

257.199 -> so these are typically things that we

258.56 -> tell any of our heart failure patients

260.479 -> to look out for

263.36 -> thank you very much so it's really

265.28 -> important that our viewers understand

267.759 -> pulmonary hypertension because it can be

270.24 -> um confused with with other things that

272.639 -> are happening so thank you for that um

275.199 -> how is it diagnosed

277.44 -> so pulmonary hypertension is something

279.68 -> where if we suspect somebody has it

282.16 -> we'll typically start with a screening

284.16 -> test which is called an echocardiogram

286.4 -> or an ultrasound of your heart so we're

288.4 -> able to take pictures of the heart and

290.4 -> able to see if the heart is able to pump

292.56 -> the blood out to the body the other

294.88 -> thing these pictures will show us is if

296.96 -> there is a chance that there's high

298.72 -> pressures in the right side of the heart

300.72 -> or towards the lung arteries and it can

303.36 -> also show us the right side of the heart

304.88 -> and how well that is pumping and

306.4 -> squeezing and if that's been stretched

308.08 -> out over time so if we get an

310.479 -> echocardiogram and suspect that somebody

312.88 -> may have pulmonary hypertension the

315.44 -> definitive test to know if the pressures

317.6 -> truly are high is to go in the heart and

319.52 -> measure them so it's called a right

321.84 -> heart catheterization where we'll

323.68 -> typically go in a vein either in your

326.4 -> neck or in your groin with a plastic

328.88 -> catheter and we actually

330.96 -> lead that up and inside your heart and

333.12 -> measure the pressures in your heart and

335.039 -> up into those pulmonary arteries and

337.84 -> that test will also give us a good idea

339.759 -> if your heart is then able to get blood

341.919 -> around to your body like we were talking

343.919 -> about earlier

346.72 -> great that's that's very interesting

348.96 -> what are the

350 -> um different types of pulmonary

351.759 -> hypertension so there's a lot of things

354.08 -> that can cause pulmonary hypertension

356.24 -> and as a result pulmonary hypertension

358.319 -> has actually been broken down into five

360.8 -> categories so group one through group

364.24 -> five pulmonary hypertension

366.479 -> so group one refers to pulmonary

368.639 -> hypertension that is truly caused by an

371.52 -> issue with those arteries themselves

373.6 -> where the arteries have get have gotten

375.6 -> damaged over time with high pressures

378.16 -> and continue to cause those pressures to

380.479 -> keep rising so that's group one or

382.8 -> pulmonary arterial hypertension which

385.84 -> can sometimes be associated with things

388.08 -> like lupus or sarcoidosis or other

391.039 -> medical conditions that can lead to that

392.88 -> as well

394.4 -> or even hiv for example

396.8 -> group two pulmonary hypertension refers

399.36 -> to high pressures in the lung arteries

401.36 -> that's actually caused by the left side

403.759 -> of the heart so if you have left-sided

406.08 -> heart failure or any valve disease in

408.8 -> the left side of the heart that can

410.639 -> cause the back pressure to happen into

412.8 -> the lungs causing the pressures in the

414.319 -> lungs to be high so that's group two

416.24 -> pulmonary hypertension

418.08 -> group three pulmonary hypertension

420.24 -> refers to any lung disease or low oxygen

423.759 -> levels that can cause those pressures to

426 -> become high so that could be copd it

428.24 -> could be asthma it could be

430.24 -> sleep apnea any of those things that can

432.8 -> then cause the pressures in the lung

434.479 -> arteries to become high

436.479 -> group four pulmonary hypertension or

439.28 -> also called c-tef chronic thromboembolic

442.56 -> pulmonary hypertension refers to if you

444.479 -> have a blood clot in your lung arteries

447.599 -> and then over time that old blood clot

450.16 -> is causing a clog so your

452.16 -> blood is not able to get through there

453.919 -> and out to your body like it needs to

455.919 -> and that pressure builds up and causes

458.24 -> high pressures or pulmonary hypertension

460.319 -> group four and then group five is a

462.72 -> category that can be all sorts of other

464.479 -> things that may be contributing and

466.16 -> causing again with sarcoidosis as i had

468.16 -> mentioned earlier um so that's a tricky

470.72 -> one because it we typically will check

473.28 -> all sorts of blood work to look for

475.039 -> autoimmune meaning the body working

477.199 -> against itself type of conditions that

479.68 -> can cause pulmonary hypertension as well

483.44 -> okay thank you so five different types

485.919 -> when you're diagnosed with pulmonary

487.599 -> hypertension would you be

489.599 -> also told what type you have absolutely

492.96 -> because that's going to be critical when

494.639 -> we talk about how we treat that

496.319 -> pulmonary hypertension as well

498.72 -> great thank you i know we're going to be

500.16 -> talking about treatment a little bit

501.52 -> later

502.639 -> but in terms of who gets

505.52 -> pulmonary hypertension can you talk

507.44 -> about the difference between

509.919 -> adults and children can adults and

512.479 -> children get pulmonary hypertension or

514.8 -> is it only found in adults

517.12 -> yeah so that's a great question so

518.88 -> depending on the type of pulmonary

520.88 -> hypertension that somebody might have

523.2 -> typically the the types of patients that

525.04 -> i will see will be

526.56 -> adult uh patients that have pulmonary

528.959 -> hypertension and typically it tends to

530.72 -> be more common in female patients but if

534.08 -> somebody has lung disease that would

535.76 -> predispose them or if they have heart

537.36 -> disease that could predispose them so

539.04 -> those patients would be at a higher risk

540.64 -> of developing pulmonary hypertension as

542.48 -> well

543.36 -> there is a small subset of pulmonary

545.44 -> hypertension that's also genetic or

547.36 -> hereditary

548.48 -> so it can run in your family

550.88 -> and so that can be seen in younger

553.12 -> patients even in children

555.6 -> or if somebody has any

557.76 -> heart defects or lung defects that

559.76 -> they're born with so congenital defects

562.48 -> that can also cause pulmonary

564.32 -> hypertension in childhood as well

568.88 -> thank you very much there's a related

570.72 -> question from

572.399 -> our viewer

573.68 -> kyle

574.72 -> um

575.6 -> the the question is about

578.48 -> patients with

579.92 -> current cardiac conditions

582.08 -> um are they more

584.56 -> susceptible to

586.16 -> future pulmonary hypertension if they

588.8 -> have a current cardiac condition

591.2 -> yeah so that depends on what cardiac

593.519 -> condition they have so there's a lot of

595.76 -> cardiac conditions including blockages

597.839 -> in the heart arteries which is coronary

599.68 -> disease

600.72 -> or arrhythmias such as atrial

602.48 -> fibrillation things like that do not

604.48 -> necessarily have anything to do with the

606.399 -> pressures in the lung arteries

608.72 -> when i talk about heart conditions that

610.959 -> could be related to pulmonary

612.32 -> hypertension i'm referring back to that

614.72 -> group two pulmonary hypertension meaning

617.279 -> the left side of the heart causing back

619.92 -> pressure into the lung arteries and over

622.32 -> time those long arteries have remodeling

624.72 -> and it can get thicker and stiffer and

627.44 -> have high pressures so this is typically

629.92 -> left-sided heart failure typically in

632.8 -> patients that have heart failure where

634.399 -> their heart is stiff and not able to

636.24 -> relax to back uh to push the blood out

638.959 -> and then relax between each heartbeat or

641.839 -> sometimes if people have issues with the

644.16 -> heart valves on the left side of the

645.92 -> heart which is the mitral valve if it's

647.839 -> leaking and things like that that can

649.839 -> cause that back pressure to go back to

652.48 -> the lung arteries and cause the

653.76 -> pressures to be high so i wouldn't say

655.76 -> all cardiac conditions but there are

657.92 -> certain cardiac conditions that can

659.68 -> definitely lead to pulmonary

661.2 -> hypertension

664.399 -> thank you very much can you talk a

665.92 -> little bit more about who typically gets

668.399 -> ph are there certain people who are more

670.48 -> likely to develop that than others

673.279 -> yeah absolutely so there are certain

675.279 -> medical conditions which i alluded to

677.12 -> earlier that are associated with

679.36 -> pulmonary hypertension so there's

681.12 -> definitely certain autoimmune diseases

684.399 -> um as i mentioned lupus for example um

687.519 -> so patients with connective tissue

689.519 -> disorders those are

691.279 -> the patients that can be at higher risk

692.959 -> for developing pulmonary hypertension

698.16 -> thank you very much you talked earlier

700.32 -> about when we were talking about

702.72 -> the symptoms and how some people might

704.959 -> think that there's

706.32 -> um it's another health condition but can

708.959 -> you talk about

710.56 -> does pulmonary hypertension increase the

712.88 -> risk of developing other health

714.959 -> conditions or can it make an existing

717.2 -> condition worse

719.36 -> yeah so that's also a great question so

721.36 -> pulmonary hypertension is affecting your

723.839 -> lungs so as a result if you have any

725.839 -> other conditions that are affecting your

728.48 -> lungs then those kind of work against

730.399 -> each other and they work against your

731.839 -> body or or multiply the effects on your

734.48 -> body so anybody that has any other

736.72 -> pre-existing lung conditions pulmonary

739.279 -> hypertension can definitely make their

741.12 -> breathing or their

743.04 -> ability to do activities etc

745.6 -> a lot worse

747.279 -> the other

748.48 -> big thing that i always highlight to my

750.32 -> patients is anybody that's on oxygen

752.72 -> therapy it's extremely important that

756.24 -> patients maintain their oxygen levels at

758.639 -> an appropriate level typically over 90

761.12 -> or 92 percent

762.8 -> oxygen levels the reason being

765.44 -> our bodies are built so that if our body

768.8 -> senses low oxygen the compensation that

772.56 -> our body does is it actually creates

775.04 -> higher pressures in those lung arteries

777.6 -> so you can imagine if somebody has

779.2 -> pulmonary hypertension so they already

781.279 -> have high pressures in their lung

782.72 -> arteries

783.76 -> then if they have low oxygen levels

786.16 -> their brain tells their lung arteries to

788.72 -> clamp down even more which causes lower

791.839 -> oxygen which causes higher pressures and

794.24 -> then it's just this vicious cycle so we

796.32 -> never want to get into that situation so

798.639 -> we maintain those oxygen levels high

800.8 -> enough so they never get to the point

803.12 -> where they they kind of get spiraling

805.76 -> and have worsening of their hypoxia or

808.24 -> low oxygen levels or their breathing

811.68 -> thank you what about

813.2 -> covin 19 does

815.6 -> pulmonary hypertension increase your

817.519 -> risk for covin

819.36 -> that's a great question and it's a

820.8 -> conversation i have with all my patients

823.279 -> um so it's not to say necessarily that

826.32 -> having pulmonary hypertension would put

828.399 -> you at increased risk of developing the

830.8 -> covet infection

832.399 -> however what i tell all my patients is

834.88 -> they already have lung disease which

837.36 -> means if they were to contract covid

840.399 -> that will affect their body much more

842.639 -> severely than when they compare to

845.12 -> somebody that does not have any lung

847.279 -> disease or heart disease so i encourage

850.32 -> all my patients to be vaccinated double

853.12 -> vaccinated and when the time comes for

855.199 -> boosters i think that's going to be a

857.36 -> strong push to get boosters

859.92 -> for the vaccine as well for these

861.92 -> patients because god forbid they develop

864.48 -> covet infection they can get very sick

867.04 -> and unfortunately even with some of my

869.12 -> own patients they can end up in the icu

871.92 -> intubated and even die

875.12 -> right

876 -> thank you

877.76 -> so let's take a moment we have had some

879.839 -> additional viewers join us um wanted to

882.399 -> say welcome and thank you for joining us

884.959 -> we are talking today with advanced heart

887.36 -> failure cardiologist dr marin milani

890.639 -> krishnan and we're talking about

892.8 -> pulmonary hypertension so thank you for

895.6 -> all of your comments and questions so

897.279 -> far and if you have other questions for

899.36 -> dr krishnan please ask them in the

902 -> comments we've talked about

904 -> the causes the symptoms

906.56 -> diagnosis the different the five

908.399 -> different types

910.399 -> who gets pulmonary hypertension and um

914.399 -> is there an increased risk of developing

916.72 -> other health conditions but now i'd like

918.8 -> to

919.6 -> talk about treatment um which we uh

922.399 -> started

923.36 -> talking about a little bit or alluded to

926.48 -> the the first question i have for you is

928.639 -> what type of doctor treats pulmonary

931.04 -> hypertension

932.48 -> yeah so pulmonary hypertension is not a

934.959 -> common disease it's a very specific

937.44 -> specialized disease process and as a

939.759 -> result not every cardiologist or

942 -> pulmonologist out there

944.079 -> is comfortable or has the um the ability

947.36 -> to treat these patients so pulmonary

949.6 -> hypertension is typically treated by a

951.92 -> specialized cardiologist

954.639 -> or a specialized pulmonologist where

957.36 -> they have access to the specific

958.959 -> medications which we'll be talking about

960.88 -> shortly

962.079 -> and other

963.279 -> kind of things up their sleeves so to

964.88 -> speak in taking care of these very

966.639 -> specialized patients

970.56 -> thank you uh

972.16 -> how is pulmonary hypertension treated

974.16 -> are there and can you talk a little bit

975.759 -> about the medications used as well and

978 -> what they do

979.199 -> absolutely so this is a this is a big um

983.12 -> a big bag of things is how i would say

985.199 -> it the main thing about pulmonary

986.56 -> hypertension is you got to figure out

988.16 -> what's causing the pulmonary

989.68 -> hypertension and then as a result we

991.519 -> treat the thing that's causing it so if

993.6 -> somebody has group two pulmonary

995.36 -> hypertension caused by their heart the

997.759 -> left side of their heart then we manage

1000.24 -> that

1001.44 -> if somebody has group 3 pulmonary

1003.68 -> hypertension meaning it's caused by

1005.6 -> their lungs then we treat their copd or

1008.079 -> we treat their sleep apnea and we treat

1010.56 -> their low oxygen levels in order to

1013.199 -> lower those blood pressures in the lung

1015.12 -> arteries

1016.24 -> for the patients that have

1018 -> group four pulmonary hypertension um

1021.12 -> they might have blood clots that are in

1022.959 -> their lung arteries so we can even do

1025.76 -> surgeries where we actually go in and

1028 -> take out the clot that's sitting there

1030.319 -> in order to alleviate that pressure and

1033.199 -> bring the pressures down or even

1036.079 -> sometimes cure their pulmonary

1037.839 -> hypertension

1039.199 -> um and then in group five pulmonary

1042.319 -> hypertension we treat whatever the

1044.24 -> underlying causes can be for group one

1047.039 -> pulmonary hypertension which is

1048.64 -> pulmonary arterial hypertension that's

1051.76 -> the one that has very specific

1053.679 -> specialized medications for this

1056.96 -> for this medical process so um there's

1060.4 -> several categories three different

1062 -> categories of medications that we can

1063.679 -> use with the logic being that we're

1066 -> trying to alleviate that pressure or

1068.4 -> lower the pressure in the lung arteries

1070.559 -> so they're called vasodilators

1072.96 -> because they dilate those vessels the

1074.88 -> vaso um

1076.559 -> in your lungs specifically so sometimes

1079.28 -> um it's actually a funny conversation

1081.2 -> i'll have with my patients because one

1082.96 -> category are called phosphodiesterase

1085.28 -> inhibitors or commonly what people have

1087.28 -> heard of as viagra or cialis so peop my

1090.799 -> you know a lot of patients say doc

1092.4 -> you're going to give me viagra for my

1093.919 -> pulmonary hypertension

1095.6 -> but but that's what works so there's one

1098.4 -> category which would be either

1099.679 -> sultenophil or tadalaphyl which can help

1102.16 -> alleviate that pressure in the lung

1103.76 -> arteries there's another category of

1105.84 -> medications which is also oral

1107.52 -> medications which is masatentin um

1110.48 -> or bosentin for example

1112.64 -> and then um

1114.08 -> a third category of medication can

1116.16 -> actually come

1117.6 -> as pills as an inhaled type of

1120.48 -> medication or even continuous infusion

1123.919 -> either through an iv that we can put

1125.6 -> into their arm or subcutaneously through

1128.32 -> their skin so what we typically try to

1130.64 -> do is we try to come at it a few

1132.32 -> different ways because we've seen that

1134.4 -> when patients where we hesitate or we

1136.88 -> take longer to kind of build up the

1139.039 -> medications to treat this we see them

1141.28 -> developing right heart failure and and

1144.24 -> getting worse unfortunately so we try to

1147.28 -> come uh to treat the pulmonary arterial

1150.48 -> hypertension with one medication

1153.039 -> typically in each of these categories

1156.96 -> thank you what what happens if your

1159.76 -> pulmonary hypertension is left untreated

1162.799 -> yeah so um as i was mentioning one of

1165.2 -> the things is your oxygen levels

1167.44 -> typically tend to get lower which will

1169.36 -> then cause your pulmonary hypertension

1171.2 -> to get worse and then you kind of just

1172.799 -> spiral into

1174.32 -> right-sided heart failure

1176.48 -> so anytime when you leave these

1177.919 -> pressures untreated as i mentioned with

1179.919 -> our analogy earlier you're pinching down

1182.559 -> on that hose and if you continue to

1184.32 -> pinch down there's so much back pressure

1187.039 -> that the right side of the heart just

1188.24 -> can't handle it and people develop

1190.08 -> right-sided heart failure and can even

1192.16 -> die

1194.48 -> thank you that's that's why

1196.24 -> we want to educate um our viewers and

1199.12 -> hope that you all share

1200.799 -> this information with your friends and

1202.64 -> family because

1204.24 -> it is a serious condition and while it's

1207.039 -> rare we do want to make sure that you

1210 -> you you know what to look out for and

1211.919 -> what the risks are and make sure that

1213.84 -> you get treated for it and why you

1216.08 -> shouldn't delay that care um speaking of

1218.72 -> our viewers we have um some other

1221.039 -> questions for you from them

1223.28 -> um this one's from anna anna thank you

1225.36 -> for your question

1226.799 -> um she said i had a quad bypass eight

1230.24 -> years ago

1231.44 -> is this condition pertaining to me

1235.28 -> um so i'm guessing she's referring to a

1237.76 -> quadruple bypass surgery which is the

1240.159 -> coronary arteries meaning she had

1241.76 -> blockages and she had bypass surgery um

1244.32 -> so that would mean that she had coronary

1246.08 -> disease or heart blockages um and so

1248.88 -> typically that's not something that um

1252.24 -> that we see causing pulmonary

1254.24 -> hypertension

1255.679 -> um that being said

1257.679 -> i think um you know the big thing to do

1260.24 -> sorry

1261.2 -> it's okay um that being said the big

1263.679 -> thing to do is try to make sure that the

1265.2 -> left side of the heart is working

1267.2 -> properly because if the left side of the

1268.799 -> heart doesn't relax properly um then the

1273.2 -> that back pressure could cause high

1275.679 -> pressures in the lung arteries so not

1278.159 -> necessarily directly related to having a

1280.799 -> quadruple bypass surgery but if the

1283.2 -> heart pumping function and relaxing

1285.52 -> function

1286.72 -> is not normal that could potentially be

1290.24 -> causing some pulmonary hypertension

1293.44 -> thank you very much i have another

1295.44 -> question from rose

1297.52 -> rose asks

1298.96 -> can

1299.76 -> scarcoidosis

1301.44 -> have to do with this and can you um

1304.4 -> i know i'm not familiar with what scar

1306.96 -> coidosis is so there might be viewers

1309.52 -> that don't know either if you could

1311.679 -> address that and then answer rose's

1313.919 -> question

1315.12 -> absolutely so that's a really great

1316.88 -> question so sarcoidosis

1319.12 -> is a

1320 -> an infiltrative

1322.24 -> condition that can affect different

1323.52 -> parts of your

1324.96 -> heart for example

1326.559 -> but it's actually an inflammatory

1328.159 -> condition that can also affect your

1329.84 -> lungs and your lung arteries um so

1333.28 -> patients that have sarcoidosis

1336.08 -> again something that could also run in

1337.679 -> their families

1338.96 -> but what happens is different parts of

1340.96 -> their body will have inflammation and so

1343.52 -> if you have inflammation in the heart

1345.44 -> muscle itself that can cause

1348.08 -> infiltrative disease as we as i um

1350.48 -> mentioned earlier which can cause the

1352.08 -> heart muscle to not be able to work

1353.76 -> properly

1354.96 -> um

1356.08 -> if you have sarcoidosis in your lungs

1358.88 -> then that can affect your breathing and

1360.96 -> um and your ability um for your lungs to

1363.679 -> work properly so sarcoidosis can also

1366.799 -> directly also affect the lung arteries

1370.159 -> and can cause pulmonary hypertension so

1372.48 -> it's kind of that um that caveat to the

1375.36 -> categories of types of pulmonary

1377.039 -> hypertension as i was mentioning because

1378.559 -> sarcoidosis could truly be a group three

1381.6 -> where it's affecting the lungs it could

1383.28 -> be a group five where it's one of those

1385.36 -> kind of mixed bag other things that are

1387.36 -> affecting your whole body and it can be

1389.44 -> a group one depending on if the vessels

1391.44 -> themselves also get affected

1393.679 -> so that's a tricky one and it's

1394.96 -> definitely

1396.4 -> a subset of patients that we see

1399.28 -> and that we definitely look into and

1401.44 -> make sure that they don't have

1403.84 -> pulmonary hypertension or we treat it

1406.24 -> and treat their sarcoidosis to kind of

1408.08 -> keep it in check

1410.88 -> thank you and thank you for that

1412.4 -> question rose this is a related question

1414.88 -> from tammy um

1417.2 -> where would you find a specialized

1418.96 -> cardiologist or a pulmonary physician

1422.08 -> that's a great question

1425.279 -> um so you know a lot of

1427.36 -> a lot of health systems will have

1429.12 -> typically at least one or two

1432.08 -> providers that can take care of

1434.159 -> pulmonary hypertension um specifically

1436.88 -> so at medstar there's me

1439.84 -> and then there's also dr raymond young

1442.4 -> who works out of the baltimore part of

1444.24 -> our team um and takes care of pulmonary

1446.48 -> hypertension um and then down in dc we

1449.76 -> actually have um we're trying to build

1451.52 -> up our team so we actually have a nurse

1452.88 -> practitioner that works with us as well

1456.08 -> and then dr john scherner who is a

1458.4 -> pulmonologist also helps out with our

1461.279 -> pulmonary hypertension patients

1465.279 -> wonderful thank you great question tammy

1467.76 -> thank you very much for that we have

1469.84 -> some more questions rolling in from our

1472.32 -> viewers this one is from erica

1475.12 -> is pulmonary hypertension considered a

1477.76 -> lung disease heart disease or both

1481.679 -> that's a great question it's really both

1483.84 -> um so if you have lung disease that

1486.88 -> could cause your pulmonary hypertension

1488.64 -> or your high pressures in your lungs

1491.44 -> um if you have heart disease that could

1493.2 -> cause pulmonary hypertension but really

1495.36 -> when we get kind of at a purest level

1497.44 -> about it the pulmonary hypertension is

1499.6 -> affecting the blood vessels so it's a

1502.08 -> cardiac disease but in the lungs so it's

1504.799 -> a lung disease so it's really a

1506.4 -> combination of both

1509.52 -> wonderful thank you thanks erica for

1511.52 -> that question

1512.96 -> we have another question from bonnie

1515.2 -> um she says my mother

1517.36 -> had ph and had the treatments that you

1520.72 -> described earlier

1522.72 -> she handled it very well but eventually

1524.4 -> got nemo pneumonia and unfortunately she

1527.12 -> died six weeks later

1529.36 -> so she's wondering if this is a

1530.799 -> hereditary disease i know we

1533.2 -> talked about that earlier but if you

1534.799 -> could address that again for bonnie she

1536.64 -> says

1537.44 -> she doesn't have any symptoms but she

1539.44 -> wants to make sure she knows what to

1541.12 -> look out for so if we can um remind uh

1544.559 -> share that information again for bonnie

1546.72 -> uh

1547.76 -> i'm so sorry to hear that bonnie um so

1550.799 -> you know there is a subset a very small

1553.2 -> subset of pulmonary hypertension which

1555.279 -> does uh run in families or is hereditary

1558.559 -> but it's pretty uncommon

1561.12 -> usually if somebody has pulmonary

1562.72 -> hypertension it'll be one of the other

1564.32 -> ones that i was talking about or it

1566.159 -> might even be group one pulmonary

1568.159 -> arterial hypertension but not

1570.24 -> necessarily something that runs um in

1572.72 -> your family um so that being said the

1575.679 -> things to be looking out for um would be

1578.559 -> the heart failure type symptoms as i was

1580.96 -> mentioning earlier so one would be your

1583.76 -> uh

1584.559 -> breathing pay attention to it if there's

1586.64 -> things that you were able to do three

1588.24 -> months ago six months ago that are now

1590 -> getting you out of breath that should be

1592.24 -> worrisome and that should be something

1593.679 -> that um you know should at least warrant

1595.919 -> you being seen by your primary care

1598.24 -> physician and figure out if it's

1599.919 -> something that needs to be looked into

1601.279 -> further

1602.24 -> um the other thing that goes along with

1603.76 -> that is fatigue so if you're getting

1605.52 -> tired trying to do the things you were

1606.88 -> doing three months six months ago that's

1608.64 -> something that should kind of key you in

1610.24 -> to say is something else going on should

1612.4 -> we look into this if it progresses to

1615.039 -> the point where you've got right heart

1617.2 -> failure then you might start seeing um

1620.24 -> you know swelling in your belly or

1622.08 -> swelling in your legs

1624.24 -> and those are things that can really you

1626.24 -> know it's never normal to just have

1627.919 -> swelling in your belly that doesn't go

1630 -> away or swelling in your legs that

1631.76 -> doesn't go away um you know so i think

1634.88 -> that's one of those things where you

1636.48 -> really need to look into it and make

1638.159 -> sure

1639.76 -> sorry uh really look into it yeah the

1642.88 -> people are calling

1645.52 -> but um definitely look into it and

1647.279 -> definitely make sure that you're not

1648.96 -> missing um something more serious like

1651.52 -> pulmonary hypertension

1654.88 -> thank you very much bonnie i hope that

1656.64 -> um that helped uh

1659.36 -> helped you to understand what to look

1661.279 -> out for and um yeah sorry again to

1664.96 -> hear about your mom thank you for

1667.039 -> watching and for your question

1669.36 -> this one next one is from brian is there

1671.919 -> a relationship between ph and diabetes

1676.88 -> um so typically no

1679.84 -> diabetes can definitely lead if you if

1682.48 -> it remains uncontrolled diabetes can

1684.399 -> definitely lead to heart disease

1687.52 -> and that would be something to kind of

1688.88 -> keep in check and make sure you stay on

1690.399 -> top of your diabetes but typically there

1693.44 -> is no direct relationship between

1695.279 -> diabetes and developing pulmonary

1696.96 -> hypertension

1700.159 -> thank you very much um and thanks brian

1702.559 -> for that question we have another one

1704.399 -> from terry

1706.08 -> do blood pressure readings um help to

1708.96 -> indicate that the uh this problem

1712.88 -> um so no um the short answer so your

1716.88 -> blood pressure readings or your blood

1718.72 -> pressures in your body so they check it

1721.12 -> on your arm or on your leg for example

1723.52 -> so that's the blood vessels in your body

1725.52 -> and if you have high pressures in your

1727.279 -> body that's definitely that's something

1728.799 -> that needs to be treated um but this is

1732.24 -> now specifically talking about high

1734.159 -> blood pressures in the lung arteries

1736.48 -> themselves so this is something totally

1738.32 -> separate where you say

1740.32 -> there's something causing the pressure

1741.919 -> here in the lung arteries to be high

1744.48 -> measuring the pressure in your arm

1746.799 -> it may be high it may be low it may be

1748.72 -> totally normal and it can be completely

1750.72 -> unrelated and typically is completely

1753.12 -> unrelated to what's going on in your

1755.2 -> lung arteries

1757.679 -> okay thank you

1759.679 -> another question from diane do we still

1762.08 -> use nitrous to treat lung

1764.84 -> issues so i'm wondering if she's

1767.52 -> referring to

1769.039 -> inhaled nitric oxide um which is

1771.679 -> something that we can use as a dilator

1774.64 -> in the lungs and it's typically

1776.64 -> something not something people do at

1777.76 -> home this is something for people who

1779.52 -> are sick enough to be in the hospital

1781.679 -> and they might even be on a ventilator

1783.44 -> and sometimes we can use inhaled nitric

1785.84 -> oxide to help dilate because the

1788.159 -> medicine actually goes directly into

1790.24 -> their lungs and in their lung arteries

1792.64 -> and can help dilate those vessels and

1794.72 -> drop that pressure in the lung arteries

1798.559 -> okay thank you

1800.399 -> are there any specific lifestyle changes

1803.52 -> that someone would need to make if they

1805.44 -> have pulmonary hypertension like their

1807.279 -> diet exercise

1809.12 -> um stopping to smoke for example

1812.24 -> yeah i think any uh self-respecting

1814.48 -> doctor is going to tell you stop smoking

1816.48 -> um but this is specifically something

1818.48 -> affecting your lungs so absolutely

1821.2 -> stopping smoking is huge

1823.76 -> in terms of diet

1825.52 -> so typically we tell pulmonary

1827.279 -> hypertension patients the same thing we

1829.12 -> tell our heart failure patients so you

1831.279 -> need to watch your sodium your salt

1833.279 -> intake no more than two grams of sodium

1835.76 -> in a day

1836.96 -> and we watch your fluid intake no more

1838.96 -> than

1839.76 -> 2 liters or 64 ounces of fluid in a day

1844.159 -> the reason being if you put salt into

1846.08 -> your body or if you put fluid into your

1847.76 -> body then it tends to stay there and

1849.919 -> your heart has that then has to work

1851.919 -> harder to push the blood around your

1853.919 -> body and has more work to do so if you

1856.32 -> limit the amount of fluid and salt going

1858.799 -> into your body then that's less work for

1860.96 -> your heart to do

1862.32 -> in terms of exercise um typically we

1864.799 -> tell people to stay active and do all

1866.559 -> the things um you know uh to try to have

1869.12 -> some cardiac activity three days or

1871.279 -> excuse me five days a week 30 minutes a

1873.279 -> day ideally same recommendation for any

1875.6 -> other um patients

1877.84 -> but there's something specific called

1879.679 -> pulmonary rehab that we get a lot of our

1881.919 -> pulmonary hypertension patients into or

1884.08 -> any other lung disease patients into

1886.64 -> which is typically a session about an

1888.64 -> hour hour and a half

1890.399 -> a day three days a week and patients

1893.36 -> will go there where they'll be monitored

1895.6 -> and they'll actually watch their blood

1896.96 -> pressures or oxygen counts and then get

1899.2 -> them exercising and building up that

1900.96 -> exercise stamina so they're able to do

1903.519 -> the things that they would like to do

1908.32 -> thank you very much

1909.84 -> i have um two more questions for you

1912.32 -> before we wrap up our broadcast

1915.2 -> is there a way to reduce the risk of

1917.519 -> developing pulmonary hypertension yeah

1920.559 -> so when we talk about the types of

1922.32 -> pulmonary hypertension um that are

1925.279 -> caused by something else meaning heart

1927.519 -> disease or lung disease the way to

1930.08 -> reduce the risk is to control those

1931.679 -> things so um you know somebody has sleep

1933.919 -> apnea they should be wearing their cpap

1935.519 -> every night if somebody has copd they

1937.919 -> should be using their inhalers like

1939.2 -> they're supposed to um you know if

1941.2 -> somebody has left sided heart failure um

1944.48 -> then they should be you know on the

1946.72 -> medications to keep their blood

1948.32 -> pressures down and keep their heart

1949.6 -> failure in check so these are all things

1951.279 -> that are going to

1953.12 -> help

1954.399 -> stop somebody from developing pulmonary

1956.24 -> hypertension caused by that

1958.96 -> so that being said if you have pulmonary

1961.279 -> arterial hypertension or group 1

1963.84 -> pulmonary hypertension there's really

1965.84 -> nothing

1966.88 -> specific to do to not develop it

1969.44 -> unfortunately because these are things

1971.519 -> that they just happen it's a process

1973.279 -> that happens in your lung arteries um

1975.6 -> but

1976.48 -> should you develop it then staying on

1978.64 -> top of it and making sure that you're

1980.399 -> actually you know taking the medications

1982.32 -> the way that you're supposed to and uh

1984.64 -> exercising the way you're supposed to et

1986.08 -> cetera those are things that can really

1988.159 -> help

1989.039 -> um you know keep keep somebody from

1991.44 -> progressing with pulmonary hypertension

1996.08 -> thank you very much is there a way to

1998.399 -> reverse or slow down or even cure

2001.279 -> pulmonary hypertension

2003.279 -> yeah and that's and that's really it so

2005.679 -> um so with pulmonary hypertension the

2007.919 -> main thing we're trying to do is we're

2009.84 -> trying to treat it before we get to the

2012.08 -> point that the right side of the heart

2014.159 -> um gets so weak that it fails so as we

2017.84 -> treat pulmonary hypertension the right

2019.919 -> side of the heart can get stronger and

2022.08 -> can even unstretch back to a normal size

2024.799 -> if we treat it properly

2027.279 -> but if we get to a point where in spite

2029.919 -> of all the medicines we're doing and

2032.08 -> using

2033.36 -> those three categories as i was

2034.799 -> mentioning earlier if in spite of that

2037.519 -> your heart continues to stretch and get

2040.159 -> weaker you can develop right-sided heart

2042.72 -> failure to the point that

2044.559 -> you know we call end stage heart failure

2047.76 -> or end stage pulmonary hypertension so

2050.639 -> those are patients if it's appropriate

2052.72 -> we talk about even evaluating um for a

2055.52 -> lung transplant for example um or if

2058.48 -> it's somebody who you know is not really

2060.639 -> doing the things they're supposed to be

2061.839 -> doing then unfortunately you get to that

2063.839 -> point and that's something that um that

2066.159 -> has a very high uh mortality um and

2069.52 -> people definitely die

2072.839 -> from thank you very much i have some

2075.359 -> more questions from our viewers

2077.599 -> for you um

2079.04 -> we have another question from kyle kyle

2081.119 -> thanks for

2082.159 -> uh your your question are there any uh

2085.44 -> case reports that show whether or not

2088.159 -> this is more common in one gender over

2090.639 -> another

2092.159 -> yeah so it's not really case reports

2093.839 -> there's actually um registries that have

2095.599 -> been done more so european registries

2098.079 -> but they have seen that it is more

2099.76 -> common in females um so that's something

2102.72 -> and you know depending on which

2104.48 -> registries you look at there's you know

2106.72 -> um a higher either twofold or fivefold

2109.599 -> higher chance in females but but

2111.52 -> everybody agrees that it tends to be

2113.52 -> more common in females okay thank you

2117.44 -> and thank you kyle um this one's from

2119.839 -> michelle

2121.04 -> uh she asked would your pulse pulse ox

2124.56 -> um be low

2126.079 -> if you have pulmonary hypertension yeah

2128.72 -> so your pulse ox or your pulse oximeter

2130.88 -> is what we were talking about earlier is

2132.8 -> what actually measures your oxygen

2134.72 -> levels in your um in your blood

2137.28 -> so if your um if your pulmonary

2140.16 -> hypertension is to the point that it is

2142.079 -> causing low oxygen levels that pulse

2144.32 -> oximeter will show low

2146.56 -> low being less than 88

2148.72 -> um but we typically as i was mentioning

2150.4 -> earlier like to keep it around 90 or 92

2152.56 -> percent specifically in these pulmonary

2154.56 -> hypertension patients so that they don't

2156.8 -> spiral into having higher pressures by

2158.8 -> having low oxygen levels um so

2162 -> when pulmonary hypertension is first

2164.079 -> diagnosed a patient may or may not have

2166.72 -> low oxygen levels

2168.8 -> but they typically tend to develop that

2171.119 -> and typically end up needing oxygen

2174 -> therapy wearing oxygen

2176.16 -> either when they exert themselves or

2177.76 -> when they sleep or sometimes all day

2180.4 -> in order to keep their oxygen levels

2182.48 -> where they need to in order for their

2184.24 -> heart to get blood around their body and

2185.92 -> oxygen to all your organs like you need

2187.76 -> to

2189.2 -> okay thank you thanks michelle for that

2191.52 -> uh question another question from erica

2194.72 -> thank you erica in addition to blood

2197.76 -> pressure medicine should someone with

2199.599 -> pulmonary hypertension be regularly

2202.56 -> using inhalers or

2206.28 -> bronchodilators to help lungs function

2209.119 -> better

2210.4 -> so it depends on what's causing their

2211.92 -> pulmonary hypertension if somebody has

2214.48 -> a medical condition where they've been

2216.32 -> prescribed

2217.68 -> the bronchodilator so uh

2220.24 -> copd or asthma you know then those

2223.92 -> medications are absolutely appropriate

2226.079 -> in order to help the lungs work properly

2228.24 -> which can then help the pressures in the

2230.32 -> lungs come down

2232.72 -> if somebody has no lung disease no lung

2235.599 -> condition then there's no utility

2237.76 -> there's no use of

2239.28 -> any bronchodilators or any inhalers

2242.16 -> because they don't work on the blood uh

2245.44 -> pressures in those lung arteries um

2248 -> there is one medication i was kind of

2250.88 -> alluding to earlier um that we use which

2253.839 -> is called tyveso and that's actually an

2255.76 -> inhaled medicine

2257.76 -> that goes directly into the lung

2259.68 -> arteries and dilates them so this is

2261.68 -> different from regular inhalers that we

2264 -> talk about like somebody having their

2265.28 -> albuterol inhaler this is a specific

2267.599 -> pulmonary hypertension medication that

2270.24 -> happens to be inhaled so you can breathe

2272.32 -> it in and it can dilate those blood

2274.24 -> vessels

2276.72 -> thank you speaking of

2278.96 -> treatment we have a question from dana

2281.599 -> um she says my son had pulmonary

2284 -> hypertension in utero and up until four

2286.96 -> years of age and is continuously

2288.96 -> followed yearly

2290.56 -> she's wondering if um

2293.28 -> these two treatments are still something

2295.52 -> that are used she says um

2299.76 -> let's see

2300.839 -> sildentifill and lasix

2303.839 -> are those skill treatments for pulmonary

2305.52 -> hypertension yeah so sildenafil um is

2308.48 -> the generic name for viagra um as i was

2311.68 -> talking about earlier so that's

2312.88 -> definitely one of the three categories

2314.72 -> um it's in one of the three categories

2316.96 -> for pulmonary hypertension treatment

2319.44 -> and then lasix or furosemide is actually

2322.32 -> a water pill so we use that in pulmonary

2324.8 -> hypertension patients to keep the extra

2326.56 -> fluid out as i was mentioning earlier we

2328.88 -> watch what fluid goes in and sometimes

2330.56 -> we may even need water pills like lasix

2333.52 -> um to help patients pee out that extra

2336 -> fluid

2336.96 -> so it's definitely something that we use

2338.88 -> both of them are medications we use

2341.359 -> often

2343.119 -> thank you very much um

2345.28 -> what is a water pill

2347.599 -> yeah i mean i think

2350.56 -> yeah so i just i say water pill um it's

2352.8 -> called it you know because it makes

2354.56 -> sense to certain people um they drink

2356.88 -> water and then it makes them pee out the

2358.32 -> water what i'm referring to is a

2359.68 -> diuretic um so really any medication

2362.4 -> that makes you pee yeah so either a

2364.16 -> diuretic or a water pill and there's

2365.68 -> several out there

2367.2 -> but we use you know furosemide um we can

2369.92 -> use um bumex or bumetanide sometimes we

2372.32 -> use torsimide as well um they all work

2374.88 -> on your kidneys to help you pee out

2376.32 -> extra fluid

2377.76 -> gotcha thank you for that yeah what is

2381.119 -> so um thank you for to all of our

2383.839 -> viewers who have asked questions

2385.76 -> especially our our viewers who've been

2388 -> watching the entire broadcast and and

2390.24 -> have had multiple questions we hope that

2392 -> this

2393.2 -> has really helped you to understand and

2396.4 -> learn more about pulmonary hypertension

2399.359 -> before we conclude our broadcast uh dr

2402.48 -> christian what is the the key takeaway

2404.56 -> you'd like our viewers to walk away with

2406.4 -> today after watching this broadcast

2408.8 -> yeah so i guess the main thing to say is

2410.8 -> you know pulmonary hypertension it's

2412.72 -> rare but it is a very serious condition

2415.92 -> so it's something where if you suspect

2418.16 -> that you might be having any of the

2419.599 -> symptoms i was talking about earlier we

2422.24 -> don't delay any care you should really

2424.24 -> be seen as soon as possible the reason

2426.24 -> being we can start treating it we do the

2428.56 -> testing figure out what's causing it

2431.119 -> figure out if you truly have it and then

2433.359 -> start treatment as soon as possible in

2435.28 -> order to kind of prevent or undo that

2438 -> extra stress on the right side of your

2439.68 -> heart

2440.56 -> so it's it's very very important um to

2443.52 -> look into it if this is even a potential

2445.76 -> thing

2446.64 -> that you think you might have or that

2448.24 -> runs in your family etc um and and not

2451.44 -> delay medical care

2454 -> thank you that is great advice uh dr

2456.72 -> krishnan thanks again for your time and

2459.52 -> for joining us today educating our

2461.28 -> viewers thanks to everyone who watched

2463.76 -> today uh for more information or to

2466.8 -> schedule an appointment you can call

2471.56 -> 410-554-6550 we'll post that

2474.079 -> number in the comments as well and uh we

2476.96 -> hope you all have a wonderful rest of

2478.8 -> the day that you learned something new

2480.72 -> today about pulmonary hypertension and

2482.96 -> that you all stay safe and well dr

2485.599 -> christian thanks again of course thank

2487.68 -> you so much for having me

2489.52 -> of course

2490.56 -> bye everybody we'll see you next time

2492.48 -> bye

Source: https://www.youtube.com/watch?v=CqkrXOxCPTc