Pulmonary hypertension treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
Pulmonary hypertension treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
Created by Amy Fan.
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Content
2.503 -> - [Voiceover] Talking about the treatment
3.622 -> of pulmonary hypertension
can be a little complicated
5.917 -> just because it can be caused
by so many other things.
9.737 -> And in fact, our diagnosis is not over
12.195 -> just having found with the catheter
14.783 -> that the pressure's elevated
in the pulmonary artery.
18.026 -> The workup is usually huge and extensive
20.586 -> to find out why we have
pulmonary hypertension.
24.975 -> So our treatment really goes off of that.
26.993 -> So you have to treat the underlying cause.
29.207 -> And that really is the theme
of this whole treatment video,
33.698 -> is that we have to treat the underlying,
36.379 -> whatever it is, that's causing
the pulmonary hypertension
39.244 -> in the first place, treat
the underlying cause, okay.
43.754 -> So intuitively, we go to the lungs first.
45.603 -> Pulmonary hypertension, what can happen
47.472 -> in the lungs that lead to it.
49.24 -> If we have asthma or COPD
or chronic bronchitis,
52.166 -> whatever it is, we'll try to
reverse the underlying disease.
55.62 -> So we might give patients drugs
57.387 -> to decrease the hypoxia
or the lack of oxygen,
61.41 -> the lack of good ventilation in the lungs,
64.254 -> so help with our pulmonary hypertension.
67.526 -> And like I promised before,
68.642 -> I'll always mention in the lung videos
71.71 -> that we have to stop smoking.
74.046 -> Smoking itself can lead
to pulmonary hypertension,
76.505 -> not to mention the other
things, like cancer
79.226 -> or obstructive diseases that
can happen in the lungs.
84.354 -> Sometimes if we do the
workup and we can't find out
86.467 -> why we have pulmonary hypertension,
88.336 -> we call it idiopathic or that
it just over rises on its own.
92.215 -> In this case we might give patients
94.125 -> what's called endothelin antagonists.
97.071 -> So endothelin is literally the chemical
99.448 -> that's released by the lung tissue
102.069 -> to restrict the pulmonary vasculature.
105.055 -> And sometimes that's necessary
and it's good for us.
108.062 -> But an overproduction would give us
109.911 -> pathologic pulmonary hypertension.
112.227 -> And we want to give agonists
or, I'm sorry, antagonists
115.64 -> to stop that process.
117.591 -> So this is going straight to the source.
120.264 -> But we usually don't want to go there
122.068 -> unless we can rule out
other treatable causes
124.567 -> of pulmonary hypertension in the lungs.
127.388 -> So going outside the lungs,
128.545 -> we're really entering a
huge pool of possibilities
131.248 -> of things that can cause our condition.
134.256 -> In general, if we have our
heart and lungs like this
138.278 -> and we think about the ways
in which they're connected,
141.703 -> it's the right side of the heart
143.353 -> that pumps blood to the lungs,
147.284 -> and then it's the left side
that it is returned to.
151.233 -> I'm not going to worry about
which chamber right now.
153.946 -> But just think of the sidedness
of it, right and left.
157.507 -> So to treat problems on the right side...
159.58 -> by the way, we're treating the symptoms
161.286 -> as well as the causes.
162.769 -> So a lot of symptoms on the right side
164.435 -> is over volume, overloading of fluid.
169.54 -> So we might give diuretics
172.347 -> to have them pee out some
of this extra volume,
175.674 -> just decrease the blood volume,
177.828 -> which will make them feel
better symptoms-wise.
180.591 -> So we have less congestion
going back there.
183.162 -> We might do something
called a beta blocker
185.771 -> which decreases the
heart rate, beta blocker.
190.407 -> It plays on the beta
receptors in the heart.
192.596 -> And it decreases the rate,
194.485 -> gives the right side a chance,
196.212 -> give it some extra time to fill the lungs,
199.158 -> decrease some of the workload on the heart
201.271 -> so that it's not pushing
against a wall so hard.
204.799 -> These same treatments could
help the left side of the heart.
207.216 -> Left side, remember, can
cause pulmonary hypertension
209.777 -> because it's not pumping out blood
211.523 -> to the body like it's supposed to
212.986 -> and it backs up into the lungs.
214.632 -> So diuretics and beta
blockers can help that too
217.565 -> by decreasing the workload,
219.252 -> giving this dysfunctional left heart
220.918 -> a better chance to do its job.
223.051 -> But we can also give drugs
224.981 -> that give the left side
a little bit of a kick.
227.538 -> So there's a whole big class of drugs
229.435 -> called the inotropes or ionotropic drugs
232.889 -> that bank the heart work harder
236.505 -> so we can increase the motor
power behind the left side,
241.121 -> make it push out harder
242.807 -> so we have less backup in the lungs
244.636 -> and can alleviate the
pulmonary hypertension
247.196 -> or if we have a valve
issue on the left side
250.243 -> that's causing this ineffectiveness,
253.169 -> we could repair the mitral valve
256.632 -> because mitral valve dysfunction
259.06 -> can lead to decreased left side work
262.272 -> which leads to backup into lungs.
264.592 -> And then sometimes we can
give people anticoagulate.
268.089 -> And then sometimes we can
give people anticoagulants
270.182 -> because one thing that could cause
273.935 -> really bad hypertension in the lungs
275.858 -> is if you have little blood clots.
278.012 -> A big blood clot in the
lungs would kill you.
281.201 -> But if you have lots of little ones,
283.091 -> they're not enough to kill ya,
284.249 -> but it would definitely
create a lot of hypertension
286.179 -> and blockage in the vasculature.
288.393 -> So anticoagulation could be for people
291.278 -> who are prone to make these blood clots.
293.92 -> Coagulation.
296.27 -> And then of course you want to investigate
298.098 -> why they're prone to coagulation
300.517 -> in the first place and treat that.
302.466 -> So our general idea, again,
304.153 -> is just to show you that
305.615 -> it literally could be
anywhere in the body.
307.952 -> The problem could be in the liver.
309.618 -> It could be in the feet.
310.776 -> But the point is that we
always come back to treating
313.214 -> what we can treating the underlying cause.
316.114 -> And a lot of times we're
dealing with symptoms
318.084 -> rather than causes because
the cause can be hard to treat
321.416 -> or it's global or we're
dealing with a side effect
324.037 -> of a drug that's necessary
to treat something else.
327.592 -> So it's a little bit of a balance act.
329.624 -> And sometimes we might
need to get really drastic.
332.874 -> And then the heart,
surgically we can sometimes
335.678 -> cut a hole between the top chambers,
339.843 -> the right and left atria.
341.489 -> The procedure of cutting this
hole is called a septostomy.
344.983 -> So sept for the septum
and the wall between them.
347.848 -> And ostomy is a hole.
350.306 -> All this does is alleviate some of that
352.562 -> buildup pressure on the right side.
354.614 -> So if we have a lot of
backup in the right side,
356.564 -> it's causing right heart failure
358.535 -> and congestion and swelling,
360.547 -> then cutting this hole allows some of it
362.815 -> to go to the left side,
364.366 -> which will lower the oxygen
content in the left side.
367.109 -> But we are willing to sacrifice that
368.734 -> to equalize the pressure a little bit
370.603 -> and alleviate some of this
right heart failure symptoms.
374.382 -> And surgically, if we
do get a lot of clots
376.312 -> that we can't take care
of with anticoagulation,
379.547 -> there's an option to go in
380.885 -> and physically remove
the clots surgically.
385.131 -> And of course, you can't
do this every week.
387.57 -> This is kind of drastic.
389.703 -> But if we think the culprit
are these blood clots,
392.08 -> then we can remove them and prevent them
393.786 -> from coming back with drugs,
395.595 -> then sometimes it's worth doing.
397.728 -> And then at the end of the day
399.231 -> we always have transplant as an option
402.096 -> if all other therapies fail
404.007 -> or we think we can switch out the lungs
406.282 -> and prevent the same thing from happening,
408.882 -> then we can always go to
transplant as a last resort
412.194 -> and give this person a new set of lungs.
415.239 -> So pulmonary hypertension,
416.719 -> very complicated to treat.
418.406 -> And the treatment depends largely
420.762 -> on a good workup to find
the underlying causes
424.42 -> and playing with the drugs
to control our symptoms
426.695 -> and reverse the cause.
Source: https://www.youtube.com/watch?v=RSMtgI8yyfg