Pulmonary Arterial Hypertension

Any news on the insurance approval front @mbarrons60 ?

Yes finally the appeal was approved! It’s scheduled for June 12th. Looking forward to getting some answers hopefully.

Great new @mbarrons60 , you have to feel some relief. I hope you come back and report how you are doing and what you find out.

How are you feeling?

I’m feeling about the same. Blood ox is still in the 80’s if I don’t have my oxygen on. Still out of breath. The last couple of weeks I’ve had problems with my blood pressure. With my Addison’s disease, it flares up when I’m under any kind of stress. It makes me have orthostatic hypotension. For example: sitting down my BP is 70/46 and when I stand up is drops to 54/38 and I start to pass out. So I have to lay down to bring it up.
The Endocrinologist increased my meds this week. Hopefully they help.

A delayed update to my potential "pulmonary hypertension" diagnosis. I had a repeat echo done in early June this year, after the first one showed a pulmonary artery pressure of 65 mm/Hg. The second echo showed the pressure was somewhat less, at 58 mm/Hg, at least that's in the right direction. I saw my cardiologist's PA shortly after that, and we discussed PH in general, though he didn't get into which type he thought I might have, my impression was that they believe from my medical/cardiac history and findings it'd be type 2, ie, secondary to left-sided heart disease. A visit to the cardiologist a few months after that confirmed that they believe this is the type as I do have some other echo findings that confirm mild left-sided heart disease. My symptoms are also very mild- a small amount of shortness of breath at times, but far as I can tell this has not progressed in the last year or so, and continuing to take the furosemide, watching my diet and regular exercise has helped to reduce the edema, so we agreed the best thing to do for now is to continue with that regimen. From what I've read, and this was confirmed by the cardiologist, treating the underlying causes of the type 2 PH is the treatment of choice for this condition, and I'm already taking the beta blocker ( metoprolol), ARB ( losartan and chlorthalidone ( another diuretic) for high blood pressure and heart rate control, and have been taking the furosemide. He mentioned that he prescribes sildenafil for this PH when the patient is symptomatic, to relieve shortness of breath, but we both agreed I wasn't symptomatic enough to begin taking it, so I think the mainstay of treatment for this PH, at least for me, for now, is the meds I take already, including the furosemide, and life style measures such as diet ( watch the salt) and exercise. He ordered another repeat echo to check again on the pulmonary artery pressure- will have that in December, he did say we had to keep an eye on that. He also suggested that I lose the excess weight I carry around as that also puts extra strain on the heart.
This is exactly what I thought might be happening. So I wasn't surprised when the cardiologist came up with it too.
From what I've read, they don't recommend all the other drugs that have come out to treat PAH, in treating type 2 PH, but that sildenafil can be useful in relieving shortness of breath associated with this conditions. Thank goodness, I don't need it at this point. So for me, at this point, I guess we could say the furosemide will at least do its part in keeping my PH at least at bay.

@marybird thanks for your update. I had a check up with the PA last week and got nowhere with my request to now have a right heart cath to officially diagnose my supposed PH. Says i dont need it and prescribed a GLP1 (Zepbound) instead. I am not obese but definitely in the overweight category. Have lost 15 lbs in the last 6 months. He says my PH is caused by sleep apnea but ive been treated for that for 10 years with Cpap! So how can that be? Well my drug ins would not approve the med (a weekly shot you have to take forever) and i am not in favor of it anyway. Was shocked he would prescribe it. At this point am in limbo and just continuing to take tadalafil (Cialis). Scheduled for another echo in 6 months. No side effects from tadalafil and i “ think” it helps me.

@carculmer I'm betting they don't want to do a right-side heart cath on you because the observed pulmonary artery pressures on your previous echocardiograms ( in the low 40's, if I recall?) were not that high, almost borderline. The right sided cath pulmonary artery pressures are always significantly lower than those seen on echos, ( the cath pressures have their own normal ranges as well) and it might well be that your right sided cath pressures might be normal. It's probably a good idea to continue to monitor your pressures with echocardiograms, as these are noninvasive methods of letting them know how those things are going.

My cardiologist didn't make any mention of a right-sided cath for me either, and I sure wasn't going to bring it up either as I really don't want to go through that especially if my cardiologist doesn't feel it's warranted at this point. If he believes the PH is due to left-sided heart disease I'll be happy to concentrate on treating that as we need to. He says he does prescribe sildenafil for patients for whom shortness of breath is problematic but we both felt I'm not symptomatic enough ( it's not all the time and it's very mild and short-lived) to take that medication at this point. When he mentioned the weight loss I jumped the gun and told him I had no intentions of taking any of the weight loss drugs (GLP-1's) but would do it the ways I'd found it worked for me, and he laughed and said he wouldn't prescribe any of those. Honestly, they might work but I'm afraid of the side effects, including the possible long term side effects I may not even live long enough to see ( I'm 78). My daughter's taken those, and has had pancreatitis twice, I have enough GI oddities already and don't want any more. I'm hoping the spectre of escalating heart failure if I do nothing will be enough motivation to keep me on track for the life style and exercise I need to keep it all as good as I can.

We'll see what the echo I have scheduled in December brings...