Brief Answer:
i would need some info for better ans

Detailed Answer:
Hi,

Welcome to Health Care Magic,

I am Dr.Muhammad Ahmad, I have read your message and will try to help you in best possible way.

I would like you to give me some more info in this regard.

Here i will ask you some questions to guide our conversation


1) Can you please upload your echi report.

2) what were the symptoms when you went for medical care

3) what are your symptoms now

4) Any edema in feet?

5) did you ever get heart attack?

6) ANY medical issues you suffer other than this?


Waiting for your input.

Dr.Muhammad Ahmad

M.B.B.S

Resident M.D.(cardiology)

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Brief Answer:
Things seem good yet.

Detailed Answer:
Hi,

Thanks for writing back.


Your Answers were really helpful and I have seen your reports. I will hereby try to help you out according to your reports and situation.

You asked if 51 is a bad pressure for right ventricle, yes it shouldn't be that much high, it SHOULD NOT be exceeding 25mmhg or at XXXXXXX 30mmhg , you increased pressure indicates pulmonary hypertension.

What happens because of that? right heart has to pump forcefully due to more pressure in lungs>> with time right heart keeps getting thicker and a time comes that it dilates and fails to work and that is the last stage.


STAGES:

1) Pulmonary hyper tension.

2) Right heart forces blood more forcefuly into the lungs.

3) Right heart gets thicker.


4) Right heart gets dilated and fails.

You are currently somewhere between stage 1 and 2 ... according to your echo and other reports your heart has not even started to thicken up, this means that if the problems are controlled with medication, heart will not get thicker and no complication will take place.

Here I also wanna mention that echo is a rough estimate of pressure , exact pressure can be measured by cathetrization of right heart , according to your heart's condition, either your issues are new or your heart's pressure is a bit lesser than measured by echo.

Doctor have asked you to follow up in 6 months, I believe he must be knowing what he is doing, as I told you your heart has no big damage and it can be saved with just medication and life style changes so he must have decided to keep a late follow up.

If your heart was damaged and your life was in danger he would have called for the follow up quite early.

Here I would like to suggest to you that you don't have to panic, just follow the medicine regimen religiously and do the necessary life style modification.

This will help you big time. But if you feel that medicines are not helping you or things are getting worsened despite all possible care and caution , there is always an option to ge back to your doctor.

END NOTE:

Don't panic and follow your medicine, if you feel good, well and good otherwise you have the option to get back to your GP or specialist. Things look fine right now and they will stay good if you are able to keep you lungs hypertension under control.

If you need to know about life style changes you can do, I am always here to help you.
This is a chroic thing and you can not get rid if it completely , all you can do is to keep it under control and believe me it can be kept under control.

I Hope this answers your question, if your have more queries feel free to ask, otherwise close the discussion and rate it. Wish you the best of health.



Regards,

Dr.Muhammad Ahmad.

M.B.B.S.

Resident M.D.(Cardiology).

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Brief Answer:
Here are some possible causes of PAH in your both

Detailed Answer:
Hi,

I will answer all your questions,

Just read the text carefully , here are some environmental factors which can cause PAH in both husband and well,, tell me what can be true in your case?

****Environmental Factors

Three environmental factors have been convincingly associated with an increased risk of the development of PAH: hypoxia, anorexigen (appetite suppressant) exposure, and central nervous system stimulant use.

Hypoxia

Hypoxia causes vasodilation in systemic vessels, but vasoconstriction in the pulmonary vasculature. The acute effects of hypoxia are regulated, in part, by endothelin-1 and serotonin, and, in part, by changes in ion channel-associated activity in pulmonary vascular smooth muscle cells. During acute hypoxia, voltage-gated potassium channels in these smooth muscle cells depolarize, thereby increasing cytoplasmic calcium concentration and causing vasoconstriction. Exposure to acute hypoxia causes reversible changes in vascular tone; in contrast, exposure to chronic hypoxia leads to structural remodeling, proliferation, migration of vascular smooth muscle cells, and deposition of vascular matrix (supporting material). Although hypoxia is probably not of central importance for the initial development of PAH, it could contribute to pulmonary vascular remodeling as the disease progresses.

Anorexigens

The association between anorexigen use and the development of PAH was initially reported in the 1960s in Europe after the introduction of aminorex fumarate (an amphetamine-like drug). An increased risk of PAH has also been associated with use of the structurally related newer compounds, fenfluramine and dexfenfluramine (mimics of the naturally-occurring catecholaminergic class of neurotransmitters such as noradrenaline, serotonin and dopamine). Although the occurrence of PAH increases with the duration of use of these agents, increased pulmonary artery pressure can result from as little as three to four weeks of exposure.

Central Nervous System Stimulants

Use of methamphetamine or cocaine has been associated with an increased risk of PAH. Although contaminants in synthesized methamphetamine could possibly play a causative role, PH occurs with contaminant-free fenfluramines and aminorex fumarate, both amphetamine-like anorexigens. In a recent autopsy study of heavy users of cocaine, 20% of them demonstrated pulmonary arterial medial hypertrophy without evidence of foreign-body microembolization (minor blockages of blood flow) in their lungs, findings consistent with PAH.


Waiting for your response

Dr.Ahmad

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Brief Answer:
here are answers

Detailed Answer:
Hi,

Thanks for writing back I deliberately didn't reply to your other questions and mentioned in my previous responce that i will answer them in my next response after i can guess the cause of you BOTH having same issue. Thats why i shared causes .


1-What are the typical medications for pulmonary hypertension? When my husband was on epoprostenol, his liver was a mess—the worst liver the medical examiner had ever seen. Are there other options in the drug world? At what point would they be administered?

I am sorry to know that your husband's liver was damaged but there are two things here

1) The drugs doesn't damage every liver...these are few unlucky livers which get damaged.

2) Pulmonary hypertension damages right heart which puts pressure on liver which damages it, so when these both mechanisms combine , damage is real bad.

Are there any more meds? yes there are meds:



1) Prostaglandins


2) Endothelin receptor antagonists

3) Phosphodiesterase type 5 inhibitors


4) Activators of soluble guanylate cyclase

All these meds more or less do the same thing, they dilate pulmonary arteries (most arteries of the body rather) and this dilation causes decreases in pulmonary hypertension. This saves heart.

There is a surgical procedure :

Atrial septostomy is a surgical procedure that creates a communication between the right and left atria. It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood (hypoxia).

These meds are usually started when simple meds with less harmful side effects can not control the problem.

2-Isn't it absolutely mind-blowing that my husband also had pulmonary hypertension? Could there be an environmental cause? The odds against the two of us having it are pretty high, no?

Yes it's mind blowing indeed, I could say that your husband has pul hypertension due to hypoxia and you have idiopathic but I as a science student feel it hard to believe, there must be some correlation, may be you didn't notice such thing or may be medical science doesn't know it yet but I don't believe in such a coincidence frankly speaking and It's a shame that medically I can't come with a common cause though for your case i have read loads and loads of material to find some clue but may be there is something in your environment and history which we didn't consider worth or may be medical science hasn't reached there yet.



3-Is there any possibility of a correlation between the RVSP of 51 and a EF of 92%, or not?

They may be related...it means lungs are not letting enough blood to reach the left ventricle and left ventricle has to throw out 92% of its contained blood to supply the body.
This in normal cases is 65%


4-My understanding is that idiopathic PPH shows no hope. IF there is a cause to be found for this, and if it can be changed, is there hope?

Infact according to researches idopathic PPH has more servival rate 52% patients were surviving after 7 years in idiopathic compared to 49% with other causes.

5-What further tests would you recommend at this point? I want to find the CAUSE of what is going on.


I this point at echo was enough in next visit discuss with your doctor about right heart catheterization if he deems it necessary. keep checking your BP and keep observing your ankles for edema if you see edeme rush to dr,.


I Hope this answers your question, if your have more queries feel free to ask, otherwise close the discussion and rate it. Wish you the best of health.



Regards,

Dr.Muhammad Ahmad.

M.B.B.S.

Resident M.D. Cardiology

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Brief Answer:
Here are some points on life style.

Detailed Answer:
Hi,

Thanks for writing back,

>Get plenty of rest.

Resting can reduce the fatigue that may come from having pulmonary hypertension.


>Stay as active as possible.

Even the mildest forms of activity may be too exhausting for some people with pulmonary hypertension.

For others, moderate exercise such as walking may be beneficial, and using oxygen during exercise may be especially helpful.

But first, talk to your doctor about specific exercise restrictions. In most cases, it's recommended that you not lift more than 50 pounds (22.7 kilograms). Your doctor can help you plan an appropriate exercise program.


Don't smoke

. If you smoke, the most important thing you can do for your heart and lung health is to stop. If you can't stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit. Also, avoid secondhand smoke if possible.


>Avoid traveling to or living at high altitudes.

High altitudes can worsen the symptoms of pulmonary hypertension. If you live at an altitude of 8,000 feet (2,438 meters) or higher, your doctor may recommend that you move to a lower elevation.


>Avoid situations that can excessively lower blood pressure.

These include sitting in a hot tub or sauna or taking long hot baths or showers. These activities lower your blood pressure and cause fainting or even death. You should.

> avoid activities that cause prolonged straining, such as lifting heavy objects or weights.


>Find ways to reduce stress.

These can range from yoga, meditation and biofeedback to warm baths, music or a good book. Try to allow at least 30 minutes a day for an activity you find relaxing. Many people with pulmonary hypertension find that simply reducing stress can greatly improve the quality of their lives.


>Follow a nutritious diet and stay at a healthy weight. It's likely your doctor will recommend limiting the amount of salt in your diet to minimize swelling of your body's tissues (edema). Most experts agree that you should eat no more than 1,500 to 2,400 milligrams of salt a day. Keep in mind that processed foods often are high in salt, so it's important to check labels carefully.

Are you following any diet or life style change these days?

Controlling salt intake?

Regards Dr.Muhammad Ahmad.

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