PAH?

[saks10]

I have had an Echo done and have been told that there is an enlargement of the right side of the heart.Pulmonary hypertension and  mild right ventricular dysfunction were also mentioned by the Respiratory consultant that asked for the echo  as I have COPD but I am still waiting for an appointment to see a cardiologist.i was told I was seeing one who specialises in Pulmonary Hypertension,my questions are
Will this affect me if i ever need a General anaesthetic and if it does what precautions would they need to take.
Could Pulmonary hypertension get worse or is there a chance it will stay as it is.
Would this have a poor prognosis taking into account the Copd factor
Thank you very much

[Jonathan D. Rich, MD]

Hello and welcome to the forum.

You ask some good questions and I will try to answer them for you below.

First, COPD is a common cause of pulmonary hypertension but it is a very UNCOMMON cause of severe pulmonary hypertension.  In other words, the vast majority of patients with COPD are much more "limited" in terms of breathing, other symptoms, etc because of the effects of the COPD on their lungs even when mild pulmonary hypertension (usually the rule) is present.  Having said that, in a minority of cases, the pulmonary hypertension that develops over time (due to low oxygen levels, etc from the COPD) can occasionally be severe.  Thus, if your symptoms have changed or there is concern that you might have severe PH, the only way to truly diagnose it appropriately is with a right heart catheterization procedure.  Thus, to answer your second question first, you first need to find out if you even have PH (echo is not reliable enough).  And, if you have it, how severe it is.  If it is mild, it typically stays relatively mild but in some cases it could slowly progress.

Now, to answer your first question, if you have "severe" pulmonary hypertension, then general anesthesia can sometime be dicey and should be performed by experienced cardiac anesthesiologists who understand the potential issues/complications in the PH patient.  I'm not going to go into detail about the specifics.  If you only have relatively mild PH, the PH will not be an issue with anesthesia.

Finally, your final question is a good one as well.  Generally speaking, those who have pulmonary hypertension in addition to their COPD are likely to have a worse prognosis than those without pulmonary hypertension.  However, these data are very much skewed towards those with severe PH (not the slightly elevated pressures that frequently accompany COPD).  So dont beat yourself up over this even if you have mild PH.  If you do have PH (again, must be confirmed by cath), and your oxygen levels run low (either at rest or with exertion), then where your oxygen as much as possible as the pulmonary arteries (and the right ventricle) LOVE oxygen.

Glad to hear that you will be seeing a PH specialist.  If they disagree with any of the above, please let me know and we will find you another "specialist"

Good luck.

Best,

Dr. Rich

[nickie53]

My 16 year old daughter has severe PH she take over $15,000.00 in pills a month and she was on the shots but she cry every time i try to give them to her so they put her on 12.5 warfarin to stop the so call clots, she didn't take shots for 2 months and she didn't get a clot but her blood work was off so i had to tell then what was going on i just need some understanding this disease it heart broke to me to see my daughter go through this every day can't go no place because the sun is to hot in the summer can't go no place it's to cold in the winter i need to know if this diet pill cause this.When she was in the hospital they ask me did she had a leg injury i said no they ask did she take any medicine i said no because i forgot about the diet pills she was on when she was 12,she 15 at the time they ask me so i told what i could remember and i was upset about what they me about the disease and she could die very fast from this i just need some help with understand whats going on with my baby !!!!!!!!!!!thanks angela