Jardiance for Pulmonary Hypertension

I too have mild pulmonary hypertension, but mine is secondary to a sick left atrium from Covid that makes my mitral valve incompetent so I get back pressure into my lungs and has caused HFpEF. I too had to pressure my cardiologist to prescribe a SGLT2i, in my case Farxiga. If your pulm htn is from HFpEF, which is common, you likely will notice improved exercise tolerance. I sure did. If your pulm htn is from a primary lung problem, there are other meds that work. I totally understand why our physicians are not impressed with our pathology, but dang it, I don’t want to become impressive! As an aside, have you had trouble flying? I finally got a portable concentrator for flying, I’m okay in the air but when I try to get off the plane I’m breathing crazy hard. I think the low oxygen on the plane constricts my lungs. I was really bad at the Grand Canyon.

Thanks for your reply - my issue is not from my lungs. I have a mild
diastolic dysfunction that is apparently causing my problem. The last time
I flew was a year ago prior to my ablation for AFib and I was not in good
shape so the flight was exhausting and I vowed I'd never do it again! Now
however I'm feeling somewhat better since my Afib is gone and I'm hoping
starting Jardiance will help even more with the pulmonary hypertension
issue. I noticed a breathing problem when we went to a higher altitude in
Colorado a few years ago (before I knew what was wrong with me) and I could
hardly walk across the street! So maybe your problem at the Grand Canyon
was altitude??
Carol

@carculmer Yes, the Grand Canyon was too high for me! We were at the south rim, 7000 feet. I noticed an improvement in my walking within 2 weeks of starting Farxiga. I have to drink more water but other than that I’ve had no side effects. I changed my diet when I got atrial fib to much fewer carbs, but I have a sweet tooth. I can tell when I’ve eaten too much junk by my thirst. I wore a Stelo right before I started Farxiga and for a few weeks after. My glucose hasn’t gotten too low and it doesn’t stay as high for as long as it used to. A friend with diabetes had to stop taking it because of repeated bladder infections. That inspired me to watch my sugar.

I failed my first ablation after 5 months. I’m going to do my second one this year. My a fib burden is low but I’m very symptomatic. I hate afib. I’m glad you are a fib free now!

What is a Stelo? So far so good with no Afib since my ablation and I knock on wood every time I say that! I do think I was having "palpations (PVCs?) tho for a week after the RHC procedure and the new cardiologist suggested wearing a Holter monitor for two days but I decided against it for a couple reasons - I have an implanted loop recorder that monitors my rhythm 23/7 so I didn't see the point plus my Afib in the past was very intermittent and two days wouldn't tell me much. I really think it was from the heart being irritated by the RHC. Do you find you get tired easier with PH? What was your pressure?

I am reading these comments with interest. I also have pulmonary hypertension and Grade 3 diastolic dysfunction. Lately, I have often experienced episodes of shortness of breath. I have to sit down to rest after walking up a flight of stairs! Altitude is not an issue! I don't know if it is the PH or the HFpEF. Another factor is AFib. I have had recurrent AFib for several years and have been on nearly every antiarrhythmic - none of which worked. So, my EP believed that an AV Ablation was best for me. I eventually agreed to that (the AV Node Ablation takes out the AV Node - or bridge between the atria and the ventricles). I am now reliant on a pacemaker. A couple months ago I went back into AFib (notified from my pacemaker monitor); because of my pacemaker, my heartrate is steady. Although my EP said I would not be aware of AFib, I am wondering if the shortness of breath is due to the AFib which is affecting my atria. I have a call into my EP to see what he thinks. I have also just started Farxiga (recommended by my nephrologist), and I hope I will have an experience like Diane and have improvement in walking. As is obvious, I have several issues going on with me, so I am not sure what is causing my shortness of breath! Is it PH, HFpEF, or AFib???

@bettycll keep us posted as to what your dr says. I think Afib can make you feel all different ways - weak, breathless, lightheaded etc. i feel so much better since my pulse field ablation ( the new method) but i have arthritis so at times i cant tell if I am weak walking up the stairs due to that or some other reason being 82!

@carculmer
Thanks! So far, my EP has not responded. My oncologist believes my shortness of breath is cardiac related, so she has put in a call to my EP. As you indicate, I am not certain if the symptoms when walking up stairs are due to my multiple medical conditions (including AFib) or if it is age related! I am 80! I will keep you posted! Thank you!

Here's my experience with pulmonary hypertension, seems it was correctly called by my cardiologist as being caused by left diastolic dysfunction- as he explained it strain on my heart over the years from various risk factors, ie, chronic hard to control hypertension, being overweight, as well as other factors such as genetics. CT scans on my chest ( for cancer surveillance) showed an enlarged pulmonary artery at the base, suggestive of pulmonary hypertension and two echocardiograms showed pulmonary pressures of 65 and 58 mm/Hg, respectively. I had no symptoms I could say was due to this condition, except for some peripheral edema, I also have paroxysmal A-fib and other issues that occasional tiredness and shortness of breath could be blamed on, but no lung issues. The cardiologist prescribed a fairly low dose of furosemide ( 20 mg/day) and that took care of the edema and I just felt better. I continued the furosemide, and the cardiologist ordered another echo which I had done in February, this time the pulmonary artery pressure was within the normal range at 34 mm/Hg ( normal less than 35). I also had noted my blood pressure was consistently within the normal range with the addition of the furosemide to my medication list.

The cardiologist had emphasized lifestyle measures ( weight control, exercise, exercise, exercise and blood pressure control) as the best way to ensure as good as possible heart health. I'd seen him before the third echo showing the normal pulmonary pressure and he had instructed me to continue all the medication I was taking including the furosemide- which is ok with me as I've taken it all so long I am used to it. During my cardiac visit we discussed the other medications used for pulmonary hypertension and he said for patients who have shortness of breath and other symptoms from pulmonary hypertension due to diastolic dysfunction he prescribed sildenafil and they found that was helpful. We decided I didn't need it as I'm not really symptomatic. We were fine with just the furosemide, and my PCP ( who I saw after the 3rd echo) suggested I keep taking the furosemide as long as my kidney function remains good- it certainly seems to help with things. And it looks as though I don't need a RHC, thank goodness!

I hadn't read anything about using Jardiance or any of the other SGLT-2 inhibitors for diastolic dysfunction or other heart failure, though I now see there some emerging studies for their use in patients with pulmonary hypertension Type II- associated with right or left-sided heart failure, but that still looks to me to be a work in progress. I might caution someone using these drugs to be aware of the side effects that can occur from these drugs, in particular the development of a perianal abscess that can lead to necrotizing fasciitis, sepsis and death if not treated as soon as possible. This happened to my brother, who was taking one of these drugs for his diabetes and also had heart failure. I don't know if he was taking Jardiance or another one of the SGLT-2 inhibitor drugs, but apparently these side effects are particular to all of this type due to their mechanism of action. I think these side effects are rare, but they are certainly something to be aware of and to look out for for people using those drugs.

Thanks for sharing your experience. It's interesting that there can be such a difference in what is considered "normal" pulmonary pressure. I have read and was told that normal was 20 or less and when my third echo measured mine at 51 (after two echos in the 40s) the cardiologist said it was time to get the RHC and see what it really was. With that procedure it was measured at 30 which is still mildly elevated. I keep thinking I should be on that furosemide also.

By the way what exactly is perianal abscess - how does one get it and how can it be prevented? What happened to your brother is scary and I hope it wasn't fatal.

@carculmer
My PA pressure was 25. When I was sick in August my echo estimated it was 80! I think the dapagliflizin helped, along with the spironolactone.

The SGLT2-I certainly cause perineal infections because they lower the threshold for excretion of glucose. If your pancreas is top notch, and you don’t have diabetes it pre diabetes, your odds are pretty low. I read excellent hygiene helps, which I guess means using a wet washcloth after urinating if your sugar runs high. The Stelo is a device you plug in your arm to keep track of your blood glucose.