- 2 days ago
What is pulmonary arterial hypertension?
When there is pressure in the heart arteries supplying blood to the body, it is called systemic hypertension. Pulmonary hypertension refers to the excess pressure in the heart arteries supplying blood to the lungs.
When there is pressure in the heart arteries supplying blood to the body, it is called systemic hypertension. Pulmonary hypertension refers to the excess pressure in the heart arteries supplying blood to the lungs.
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NewsTranscript
00:00Welcome to the Skaveri Podcast.
00:17I am Dr. Anbarisu Mohanraj, Cardiothelastic Surgeon.
00:20Today we are Dr. P. Manohar.
00:22He is the clinical lead for cardiology and he takes in charge of the Heart Failure Clinic.
00:28Now, in the recent recovery clinic, we have a PH clinic, Pulmonary Artil Hypertension Clinic, open and launch.
00:36So, when we start a pulmonary artil hypertension, we will talk about Dr. P. Manohar as well.
00:45Welcome all.
00:47Welcome Dr. Manohar.
00:49It is a delight to have you here on our podcast.
00:51We have a pulmonary artil hypertension, PH clinic, launch.
00:56First, to understand the basics, in the pulmonary artil hypertension, what is hypertension?
01:02We are talking about hypertension in Thamil, Rakhtha Kodip.
01:05We are talking about BP, which is hypertension, but we are talking about systemic hypertension.
01:13That is, we are talking about systemic hypertension in Thamil, Rakhtha Kodip, or BP, which is systemic hypertension.
01:22So, when we talk about hypertension, we are talking about systemic hypertension in Thamil, Rakhtha Kodip.
01:29Pulmonary hypertension is a very special condition.
01:34Why is it that it is a pulmonary hypertension in Thamil, Rakhtha Kodip.
01:39That is, it is a pulmonary hypertension in Thamil, right side of the heart, and it is a pulmonary hypertension in Thamil, Rakhtha Kodip.
01:45That is pulmonary hypertension, that is pulmonary hypertension.
01:49That is a pulmonary hypertension condition.
01:52If you have a pulmonary hypertension in Thamil, Rakhtha Kodip is a pulmonary hypertension.
01:58So, if you are talking about the pulmonary hypertension, it is a pulmonary hypertension.
02:1720 by 10 or 12. That is, normal BP lungs are very low. 25 by 12. So, this pressure is higher than 40. That is, it is mild.
02:33If you have 60, it is moderate. If you have 60, it is severe pulmonary hypertension.
02:40That is, if you have 60, BP is higher than 40. That is pulmonary hypertension.
02:46If you have 60, it is severe pulmonary hypertension.
02:52Normally, if you go to a clinic or a doctor or a general practitioner or a family doctor, we check the blood pressure.
03:00Now, if you have a blood pressure machine in the week, it gives you an electronic reading of blood pressure.
03:07But, if you have a pulmonary hypertension, we will be able to measure systemic pressure.
03:13But, if you have a pulmonary hypertension, we will be able to measure systemic pressure.
03:17If you have a pulmonary hypertension, we will be able to measure systemic hypertension.
03:23We will be able to measure the home BP machine in the week.
03:25But, if you have a pulmonary hypertension, we can measure the lung pressure.
03:31Okay.
03:41If we see the ECOPAC, we can see the pressure on the lungs and the BP in the lungs.
03:47The ECOPAC is the easiest tool.
03:50If we see the CAT study, we can see the pressure on the lungs and the BP in the lungs.
04:01If there are clues, if there are clues, or if there are left side of the heart, there are pulmonary hypertension.
04:13So, for WHO classification, there are 4 pulmonary hypertension.
04:17For the commonest, for the convention, there is a left heart disease.
04:23That is, left side of the heart is no one or left side pressure.
04:30That is a common condition.
04:32For the major things, there are many laws, that are many laws, there is no one they are, many laws, many animals and there are many laws.
04:40There are many laws and emergencies, there is very such pressure on the lungs, and the lungs.
04:47That is, people have been中國 hypertension.
04:49Second, common conditions.
04:51This is a problem with the genetic disease.
05:00There is a complex disease in the heart,
05:04blood and the top mix, wrong connections.
05:07There are many problems with the heart and lungs.
05:12This is a problem with the CTPH.
05:19That is chronic thromboembolic pulmonary hypertension.
05:22That is correctable and reversible causes of pulmonary hypertension.
05:26But pulmonary hypertension is not a common condition.
05:30There are many problems,
05:32and there are many treatment options and outcomes.
05:36So basically, pulmonary hypertension is a problem with the heart.
05:40Lungs is a problem with pulmonary hypertension.
05:45If there are many problems with the heart,
05:47there are many problems with the heart.
05:48Like ASD or VASD,
05:49such conditions, pulmonary hypertension.
05:52If there are many problems with the heart,
05:54blood clots, lungs are locked.
06:00That is why it is hypertension.
06:02So how many patients come to pulmonary hypertension?
06:05I don't know how many patients come to pulmonary hypertension.
06:09So how many symptoms do patients come to the doctor's approach?
06:16How many symptoms do patients come to the doctor's?
06:20Usually, there are many symptoms that are common symptoms.
06:23There are many symptoms that are common.
06:25Usually, there are many patients that are in the doctor's.
06:29There are many patients that are in the doctor's.
06:31For example, there are asthma patients that have a lot of wheezing problem.
06:35At first, there are many patients that have a lot of blood clots.
06:40Their thinking that you have 1.5 million levels in the doctor's too much.
06:53Should we prefer blood?
06:55This is probably spreading blood and blood.
07:00About the symptoms of cholesterol,
07:01it would be severe hay around after 20.
07:04can't be able to do that.
07:06For example, if you have oxygen,
07:08if you have an oxygen increase,
07:10if you manage 2 liters,
07:12if you manage 8 liters,
07:14if you have 8 liters,
07:16you don't have any clue.
07:18This is the common symptom.
07:20This is the common symptom.
07:22If you have a very high level,
07:24you have a very high level,
07:26you have a very good symptom,
07:28but these are very uncommon reasons.
07:30If you have a very common symptom,
07:32if you have a very high level presentation,
07:34hemoptysis,
07:36or a very common symptom,
07:38if you have a very common symptom,
07:40if you have a very common symptom,
07:42if you have a very high level,
07:44if you have a very high level,
07:46if you have a very high level breathing difficulty,
07:48there is no giddiness.
07:50These are the common symptoms.
07:52Now, we have a PH clinic.
07:54What is unique about this?
07:56Why should we,
07:58why do we need a special PH clinic?
08:00Why should we have a cardiology or pulmonology OPD?
08:02Why should we have a special PH clinic?
08:04What is unique about this PH clinic?
08:06What is unique about this PH clinic?
08:08There is no hypertension clinic.
08:10It is a common disease.
08:12But pulmonary hypertension is an orphan disease.
08:14It is not an orphan disease.
08:16It is not one of those who governs it.
08:18It is not one of those who governs it.
08:20If it is,
08:21it is not one of those who are doing it.
08:23It is not one of those who are doing it.
08:25It is not one of those who are doing it.
08:27You say that the cardiologists are saying that they are related problems.
08:29The pulmonologists are related problems.
08:31They are seeing that they are related to their own specialty.
08:33However,
08:34it is not one of those who are related to pulmonary hypertension.
08:36It is dedicated to what there is.
08:38We are able to get the pulmonary hypertension.
08:40We have to get the right treatment.
08:41We have to get the correct treatment.
08:43One important thing is,
08:45for which in a few months,
08:47this is the treatment options are bad.
08:55Hey,
08:56my teachers and your teachers.
08:57But,
08:58if you do werd�� to get us large enough people to benefit from it etc.
08:59егда meng 아직 capacity from it,
09:01to my탄します.
09:02So,
09:03what are we part of is building a wave?
09:05If we support it as a patient,
09:07it is impossible to attestate.
09:09And that is a prognosis,
09:11more of that conditionibigiitation.
09:13pulmonary hypertension is not available in the body.
09:16So, if they are mentally
09:18or at a stage, they can say that they can
09:21take care of the lung transplant.
09:24So, if they are not
09:26able to get a diagnosis,
09:29they can take care of the diagnosis,
09:32they can take care of the treatment.
09:35So, the main pulmonary hypertension clinic is
09:38early diagnosis, appropriate treatment
09:41and most importantly, team work
09:44multi-disciplinary approach
09:46to all specialists involve
09:48the treatment.
09:50Excellent, sir.
09:51Now, you said multiple consultants
09:53and multiple specialists.
09:55Now, what are the services available
09:57under this PH clinic?
09:59What are the services available?
10:00And what are the specialists in the PH clinic?
10:02So, if the pulmonary hypertension starts
10:05as a neonatologist,
10:08so that is,
10:10the doctors are pediatricians.
10:13The two of them are
10:14because of the patients
10:16that have 4 pulmonary hypertension.
10:19This is the first diagnosis
10:22in early infancy or early childhood.
10:25This is the pediatric cardiologist.
10:27So, pediatric cardiologist
10:29who has the heart
10:31and has a wrong connection
10:32and has a blood mix.
10:33This is the third person
10:34who is referring to pulmonary hypertension.
10:36So, the third person
10:38referring to pulmonary hypertension.
10:41If we are referring to adult patients,
10:43two groups of people.
10:45One is rheumatologist.
10:46One is rheumatologist.
10:47One is a rheumatologist.
10:48Another one,
10:49the other one,
10:54But,
10:55from theاذ of SLE.
10:56In those conditions he проблемы
10:57is common generator.
10:58So, in those conditions he did,
10:59it is an unusual type of homophobia.
11:01The second is the pulmonologist.
11:03If you have a doctor, you have to treat a lung problem.
11:07If you have the underlying pulmonary hypertension,
11:10you will know that you are involved.
11:13This is our routine cardiologist.
11:16There are many cases where pulmonary hypertension is a challenge.
11:21For cardiologists and cardiac surgeons,
11:24you will see similar patients who have pulmonary hypertension.
11:29The second is the vascular surgeons.
11:33The vascular surgeons are in deep vein thromosis.
11:37When the patient is in follow-up,
11:39they have pulmonary hypertension, pulmonary embolism.
11:43Basically, there are eight to nine specialists.
11:47In this field, they have pulmonary hypertension.
11:51If they have an evaluation, they can provide services to the clinic.
11:59I am sure that will benefit the patient.
12:01All specialists and one-roof patients.
12:07New ideas come and the best of the treatment goes to the patient.
12:11Now, do you have a prognosis?
12:13Is pulmonary hypertension something to be really dreaded of mild pH?
12:19Moderate pH or severe pH?
12:21Is it a very bad disease?
12:23What is the usual prognosis?
12:25What is the usual prognosis?
12:27What is the literature evidence?
12:29What is the usual prognosis?
12:31What is the usual prognosis?
12:33What is the usual prognosis?
12:35What is the usual prognosis?
12:37This pulmonary hypertension is a very unique condition.
12:39How can you say that it is mild or severe?
12:43That is an important thing.
12:45What are the reasons for the two reasons?
12:47For example,
12:48if there is a correctable reason,
12:49or a correctable reason.
12:51For example,
12:53if there is a genetic reason,
12:55an idiopathic pulmonary hypertension,
12:57there are prognosis.
12:59That is,
13:00if there is a common one,
13:01and if there is a genetic reason,
13:02the two reasons why it is,
13:0450% is reduced.
13:06That is,
13:07if we have a patient,
13:0815 to 20 times,
13:09if we are talking about this diagnosis,
13:11if we have the same diagnosis,
13:12a chance for the two to four veces,
13:14that is a 50% chance,
13:16so this is the worst case scenario.
13:18That is,
13:19if we have a patient,
13:21as a patient,
13:22if we do that,
13:23if we have a lung transplant,
13:24if we have a lung transplant,
13:26they will have a lot of treatment.
13:27But in that case, there are many patients that are mild or moderate.
13:34And most importantly, there are correctable causes.
13:41That is, if you are in the heart, if you are in the heart, if you are in the heart, you will be completely reversed.
13:49One of the common conditions is that there is a heart wall or a heart function.
13:55In these patients, when they correct the pulmonary hypertension, they can reverse the pulmonary hypertension.
14:04The other components are medically managed.
14:07So, in the previous conditions, like CTE-PH, that is, when they are in the lung scooper, they are completely reversed.
14:19In fact, that is one of the most reassuring things in our gratifying experience.
14:26That is, my patients have full cure.
14:28Related...
14:29That is, when they use the word, they will have satisfaction.
14:32So, in the pulmonary hypertension, we have to say, in the worst case scenario, two-year survival.
14:38In the best case scenario, normal life survival is possible.
14:41So, there are two extremes.
14:42And the treatment options vary.
14:44Brilliant, sir.
14:45So, there are multiple, on the pulmonary hypertension, various scenarios.
14:51So, there may be some correctable causes.
14:53There may be totally causes where there is very ample scope for treatment.
14:59Very good.
15:00Science is advancing very fast.
15:02Off-late, what do you have to do with pulmonary hypertension, especially in the moderate or severe pulmonary hypertension?
15:12How do you have to do with pulmonary hypertension?
15:14If you have to do with pulmonary hypertension, it is a traditional challenge.
15:23But, what do you have to do with pulmonary hypertension?
15:27In the past 20 years, there are five groups of medicines that specifically target the pulmonary endothelium.
15:56That is, if you have to do with pulmonary hypertension, you have to do with that BPA.
16:01So, basically, there are five groups of medicines that are targeted at pulmonary hypertension.
16:06So, what do you have to do with pulmonary hypertension?
16:08In the past 20 years, the pulmonary hypertension is a good treat.
16:11At least, in a moderate to severe pulmonary hypertension patient,
16:15their symptoms are 40-50% correct.
16:19But, unfortunately, in this other medicine, it will prolong the survival.
16:23We have to do with pressure and symptoms improve.
16:26So, the dramatic, severe pulmonary hypertension function is in the medicines ineffective.
16:32Unless, when we have to do surgical cure,
16:36a mortality benefit, that is, when we have to do with pulmonary hypertension,
16:41if we have to do with pulmonary hypertension, the medicines are not as effective.
16:44Maybe, symptomatic benefit can be 50-60% improvement in symptoms and pressures.
16:50We have to notice.
16:51Brilliant, Sir.
16:52Sir.
16:53Sir.
16:54I mean, I am in medical school.
16:55Like, maybe, about 20-25 years back.
16:57There was only one drug.
16:59Now, what are the causes of pulmonary hypertension?
17:02Pulmonary hypertension.
17:03Surgery, what types of pulmonary hypertension are going to do with pulmonary hypertension?
17:10Well, since this is a common part, I am going to divide them into two categories.
17:15One is pulmonary hypertension due to left heart disease.
17:20So, when it comes in pulmonary hypertension with left heart disease,
17:23we can correct the surgery
17:26but it depends on what stage we are doing
17:29suppose if we are doing early stage
17:32left heart disease, i.e.
17:35left heart disease
17:38even coronary artery disease, ischemic heart disease
17:41when we are doing early, that patients can
17:44significantly reverse the hypertension
17:47in fact, if they are offering tricuspid wall
17:50surgical treatment
17:53so, left heart disease
17:56pulmai hypertension, i would say
17:59from 70 to 90%
18:02by early surgical intervention
18:04so, in these conditions
18:05in fact, we prefer surgery over intervention
18:09only for the benefit of pulmai vasculature
18:12so, somehow, surgery will benefit the pulmai hypertension
18:15better than our interventional strategies
18:17so, that is why, left heart disease
18:19surgical role is very high
18:21second group of conditions, i feel
18:24is the group which needs surgery for CTPH
18:27that is called chronic thromboembolic pulmai hypertension
18:30so, in this case, we have discussed
18:31before we have discussed
18:32we have to discuss
18:33we have to discuss
18:34we have to discuss
18:35we have to discuss
18:37in this personal opinion
18:38the benefit is far superior
18:40the benefit is far superior
18:41where patients
18:42and the result of all patients
18:47of us
18:48the benefit is much higher
18:49due to lack of awareness
18:51So, in my opinion, the second group of patients that we identified earlier, the benefit is higher and unfortunately, they will miss either due to lack of awareness or lack of facilities.
19:04In the CTPH, there is a connoisseur and a disease, that is, treatment options are limited and centers are limited. That is what I feel is the ultimate benefit of a Pulmaya Hypertension Clinic that we are able to address those kind of patients earlier.
19:23In this case, there are holes in the heart, ASD, VSD. In those conditions, pulmaya hypertension will be completely reversed.
19:33That is, in the stage, for example, I will tell you, that is, if there is a right-left pressure, either equalized or right-side pressure, not equalized.
19:45In other cases, there is a good benefit for the patients. There is a good benefit for the patients.
19:52If there is a good benefit for the patients, the patients will be able to do the lung transplant.
19:58And the results are satisfying. But, at the early stages, there is a moderate to severe Pulmaya Hypertension.
20:05There is an Eisenmenger, that is, right-side pressure, left-to-toe.
20:09In this case, there is a good benefit for the patients. In this case, there is a good benefit for the patients.
20:13In fact, in this case, there is a good benefit for the advanced techniques, like fenestrated ASD closure,
20:17or sometimes fenestration and my patch, we have had very good results.
20:22So, generally, there is a good reversal in moderate to severe Pulmaya Hypertension.
20:27And, again, the importance is, when we are able to do it at the age of 10 or 20 years,
20:32there is a good reversal in a severe Pulmaya Hypertension.
20:36If there is a right-side pressure, if there is a right-side pressure,
20:39if there is a right-side pressure, the patients will be able to do the surgery,
20:42because the surgical results will be very pathetic and we would not send those patients for surgery.
20:49Thank you, sir. So, to sum up, Pulmaya Hypertension is a,
20:53in other words, moderate or severe, it is a severe disease, correct?
20:57And, if there is a proper treatment, there is a prognosis,
21:00that is, survival is long, two years to four years.
21:03So, conditions causing Pulmaya Hypertension is a severe disease,
21:06or even if there is a negative disease,
21:08or even if there is a negative disease,
21:10or even if there is a negative disease,
21:12or even if there is a negative disease,
21:14so, rheumatologist, pediatrician, pediatric cardiologist, pulmonologist,
21:19cardiologist, surgeon, all involved in a field is Pulmaya Hypertension.
21:24So, in the conditions, medicines, lot of recent advances are needed.
21:30Patients have a good benefit in the last 20 years,
21:32over at least five classes of drugs have been in the last 20 years.
21:35So, patients have a good benefit, symptomatic benefit.
21:38But, in the medicines, survival improves.
21:41So, if there is a cure for surgery,
21:46the whole heart has a hole in the heart,
21:50and there is an ASD, VASD,
21:52that is a good response to the surgery.
21:55If there is a left-sided valve problem,
21:57or a mitral valve stenosis, or a regurgitation,
22:02it is not an ischemic heart disease.
22:05There is a heart attack of patients,
22:07and there is a heart function weaker patients.
22:09and the left side of the heart,
22:11there is a valve,
22:12and the blood supply,
22:13and the blood supply,
22:14and the coronary artery disease,
22:15address pulmonary hypertension.
22:17It is a good improvement.
22:19The rarest variety is the CTEF,
22:22Chronic Thromoembotic Pulmonary Hypertension.
22:25That is called blood clots form,
22:28that is called psilipation coagulation abnormalities.
22:31That is called lunges,
22:33and there is a layer of form,
22:34that is called pulmonary hypertension.
22:37When they are doing pulmonary thromboendotrectomy,
22:40it is a near curative condition.
22:42Is that right sir?
22:43Exactly.
22:44Thank you sir.
22:45That is one of the main reasons,
22:46we are focusing on pulmonary hypertension clinic.
22:49Because,
22:50as I said,
22:51there is a lot of treatment options,
22:52diagnostic,
22:53medical treatment,
22:54that can be done in all of the centers.
22:57But,
22:58CTEF,
22:59that is,
23:00there are surgical options in that situation,
23:04many centers in the facility,
23:06so,
23:07that is,
23:08high-end treatment offer.
23:10That is,
23:11lung transplant,
23:12that is also offered.
23:13How do you do pulmonary artery hypertension,
23:14lung transplant?
23:16Silivinary conditions,
23:17Silivinary conditions,
23:18you have to do a heart and lung transplant.
23:20What can you please explain us about,
23:21lung transplant and heart lung transplant?
23:23So,
23:24generally,
23:25in the transplant world,
23:28heart alone,
23:29results are always better than,
23:31heart lung,
23:33far better than,
23:35lung alone.
23:36So,
23:37somehow,
23:38lung results are not good,
23:39so,
23:40lung transplantation,
23:41the challenges are more.
23:43Silivinary conditions,
23:44for example,
23:45idiopathic pulmonary hypertension,
23:47there is a heart is good,
23:48one or one is not good.
23:50In that way,
23:52we have to clean the lung,
23:54and these people can do well.
23:56So,
23:57lung alone will suffice.
23:58In other words,
23:59that is,
24:00if there is a heart hole,
24:01and that is why,
24:02there is a pulmonary hypertension,
24:03then,
24:04that is,
24:05the patient has to clean the lung,
24:06and the heart hole,
24:07and the heart hole,
24:08and the intra-cardiac repair.
24:10It's good.
24:11But,
24:12there are all conditions,
24:13if there are complex connections,
24:15or wrong connections,
24:17or wrong wall dysfunction,
24:19although,
24:20that is,
24:22as I mentioned,
24:23is not feasible in the intra-cardiac repair,
24:25and that is,
24:26that is,
24:27the patients do well for heart and lung transplant,
24:28in the end block transplant,
24:29in the end block transplant.
24:30but,
24:31there are definitely,
24:32older situations,
24:33there are differenzирован,
24:34so,
24:35pulmonary hypertension,
24:36for idiopathic patients,
24:37preferably lung transplant alone,
24:38complex heart disease,
24:39with pulmonary hypertension,
24:40with the end block transplant,
24:41and the third category,
24:42simple heart disease,
24:43with the end block transplant,
24:44and the third category,
24:46And the third category, simple heart disease with pulmonary hypertension.
24:51Lung transplant plus intracardiac repair.
24:53So, we will debate treatment options.
24:57Brilliant, sir.
24:58So, as a surgeon, to end this podcast,
25:00with your permission, I will just talk about C.T.F.
25:03Sure, sir. Please.
25:04So, this is pulmonary thromboendotrectomy.
25:06This is the C.T.F. surgery.
25:09If you have done this,
25:11number one, technically, it is a little difficult surgery.
25:14Number two, there is a steep learning curve.
25:15So, number three, it is a very delicate surgery.
25:18In the patients, it is a very delicate heart lung.
25:21Connected to the patients.
25:23Normal temperature is about 36 degrees.
25:25That is, it is 18 degrees cool down.
25:27That is, from complete circulation stop.
25:30And the clots are in the clots.
25:31That is, it is fine thrombus.
25:33It is technically, it is a plane created.
25:36And it is a very high risk surgery.
25:38Because pulmonary artery pressure is in the right side.
25:43Right ventricle failure is in the right ventricle dysfunction.
25:45Most of the patients may have moderate or severe right ventricle dysfunction.
25:49Sometimes they may have,
25:50and the right heart congestion,
25:52and the liver could affect high.
25:53Umbudsman are going on.
25:54They have ascites.
25:55Call, call, call.
25:56So, if we stop the circulation,
25:58we have only 40 minutes of safe margin.
26:01And the 40 minutes complete,
26:03and the clots are removed.
26:04So, number one,
26:05we have to stick to that 40 minutes.
26:07Number two,
26:07we have to do a complete surgery.
26:09So, once we do a complete surgery,
26:11in the patients,
26:12none of the recovery.
26:13You mentioned the podcast,
26:15the patients come on a wheelchair with oxygen.
26:19They can't stop the oxygen.
26:20They can't stop the oxygen.
26:21But the patient's surgery,
26:24they can't stop the oxygen.
26:25They can't stop the oxygen.
26:26They can't stop the oxygen.
26:28But the recovery phase,
26:32when they start walking,
26:33they just start walking.
26:36Suddenly,
26:36they feel that they can breathe well.
26:38It's a very rewarding surgery,
26:39as you told.
26:41And this is one of the very few conditions,
26:42surgically,
26:43we give up,
26:44offer a cure for this patient.
26:46Thank you, sir.
26:47Thank you, everybody,
26:48for being with us on this podcast.
26:50And we'll see you back with more information.
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