High pressure in pulmonary artery?

[BigDaddy_59]

Hello all!
I had an echo cardiogram the other day and my hepa said there is a suggestion of high pressure in my pulmonary artery.

Just wondered if anyone else has experienced this?

They are sending me to see a cardiologist on Friday and probably do some more testing.

I have cirrhosis, portal hypertension with esophageal varices that have been banded 3 different times.

Getting ready to start triple with Incivek (hopefully) once this is cleared up.

Thanks,
Chris

[taccs4]

Chris,

I don't personally have experience with this but I did find this information that might be helpful:

Some diseases raise pulmonary pressures to cause pulmonary artery hypertension for unclear reasons. Perhaps an unknown toxin or chemical effects the blood vessels by causes constriction or inappropriate growth of the tissue within or around the vessel. For example, there is a condition known as portopulmonary hypertension that is result of liver failure. When these individuals receive a liver transplant, the pulmonary hypertension disappears suggesting that the failing liver is unable to clear some biochemical that leads to pulmonary artery hypertension.

http://www.medicinenet.com/pulmonary_hypertension/page3.htm

Also, I found this which relates pulmonary hypertension to liver disease:

http://www.ccjm.org/content/75/2/121.full

I hope this helps. Good luck!

[HectorSF]

Hi BigDaady.

No I haven't experienced it. But it does happen in some cirrhotics.

It is called "Secondary pulmonary hypertension" and "Hepatopulmonary Syndrome" and "Portopulmonary Hypertension".

Here is a link to The Cleveland Clinic which will give you an overview.

http://my.clevelandclinic.org/disorders/pulmonary_hypertension/hic_pulmonary_hypertension_causes_symptoms_diagnosis_treatment.aspx

Here is a much more in-depth article on pulmonary hypertension and liver disease.

http://radiographics.rsna.org/content/30/7/1753.full

"Hepatopulmonary Syndrome and Portopulmonary Hypertension"

Claudia Grosse, MD and
Alexandra Grosse, MD

"In patients with liver cirrhosis, two different causes of pulmonary hypertension may be distinguished: hepatopulmonary syndrome and portopulmonary hypertension. Hepatopulmonary syndrome develops in 15%–20% of patients with liver cirrhosis. It is characterized by an increased alveolar-arterial oxygen gradient during normal breathing of ambient room air and by pulmonary vascular dilatation, especially of the small vessels and capillaries. The presumed underlying pathophysiologic mechanism is excessive vascular production of vasodilators (particularly, nitric oxide). At histologic analysis, intrapulmonary vascular dilatation manifests as dilated precapillaries, direct arteriovenous shunts, and dilated pleural vessels.

Portopulmonary hypertension is reported to occur in 2%–5% of patients with liver cirrhosis and portal hypertension. Three mechanisms are thought to play a causal role:
First, vasoactive substances such as serotonin, interleukin 1, endothelin 1, and thromboxane, which may cause vasoconstriction and mitogenesis in the pulmonary arteries, escape hepatic detoxifying mechanisms through portosystemic shunts or are not cleared as effectively by the diseased liver.
Second, venous thromboemboli arising from the portal vein or other systemic sources may reach the pulmonary circulation through portosystemic shunts, causing pulmonary hypertension. Third, high cardiac output in patients with liver cirrhosis leads to increased shear stress on the pulmonary vascular bed, with resultant vasoconstriction, vascular remodeling, and fibrotic narrowing of the pulmonary vessels."

Your doctor will have more tests performed to confirm the exact diagnosis.

Best of luck to you! Keep us in the loop.
Hector

[eureka254]

With your history you should be on a non-selective beta-blocker; as posted above it is unusual to have pulmonary involvement with portal hypertension, but not unheard of.  Hopefully between your hepa and the cardiologist they can devise a good management plan for you.  Best wishes. ~eureka

[BigDaddy_59]

Thanks for the response!

It's good to be somewhat armed with some info before going in

I think I am leaning towards the portolpulmonary hypertension as I do have portal hypertension, plus the hepatopulmonary syndrome's fix is a lung transplant so I'll just stick with the liver transplant  :o)

Maybe my hepa or cardiologist will refer me to UCSF which probably deals with this more often and is my transplant center.

Are you with UCSF Hector or CPMC or ???

@eureka - I take 80-mg of propranolol bid and my bodies blood pressure is OK, it is just my pulmonary pressures

I let you know what they tell me tommorrow.

Thanks, Chris

[robo229]

Pulmonary Hypertension can be from cirrhosis/hepatitis.  Sucessful tx may improve this.  It'simportant to keep your lungs healthy.  If you smoke, stop.

Robo

[BigDaddy_59]

I haven't smoked for many, many years, People said I didn't look cool when I smoked, so that was enough for me to quit! Funny what we do and don't become addicted to. Wasn't addicted to nictotine whatsoever, more just the physical habit. Now alcohol and pot, that is a whole 'nother story! Not gambling either, like to win, but HATE to lose!

The cardiologist thinks there is not a problem but I am getting an angiogram on Monday to be sure. Hwe said that the pressure that they find on an angiogram is often lower than those found on an echocardiogram.

Good news!

They drew blood for some tests for the angiogram and my weekly tests for the Promacta I am on. 14 vials! I wasn't sure if I would be able to make it out of there on my own, but I did - lol!

Thanks for the input,

Chris

[BigDaddy_59]

Had an angiogram / pulmonary catheterization and everything looked great! They said my arteries looked as good as the day I was born. Hopefully they were OK back then!

Good to get some good news once in awhile!

Chris