SUPPORTIVE & PALLIATIVE CARE FOR PULMONARY ARTERIAL HYPERTENSION

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Pulmonary Hypertension is elevated blood pressure in the pulmonary artery averaging  25 mm Hg or above at rest. Elevated pulmonary artery pressure can be caused by abnormalities in the precapillary pulmonary arterioles called pulmonary arterial hypertension(PAH) .

It is a  high blood pressure that affects the arteries in lungs and right side of your heart. In  PAH blood vessels in lungs are narrowed, blocked or destroyed .So PAH patients are cared by a multidisciplinary team who are able to implement both pharmacological therapy and supportive therapy & palliative care.

Supportive Therapy includes:-

·         Oxygen Therapy

·         Diuretics

·         Anticoagulants

·         Cardiovascular Medications

·         Exercise

·         Therapy for Arrhythmias and Anaemia

Decisions regarding starting each of these therapies should be made on a patient to patient basis in the appropriate clinical scenario.

Palliative Care is broadly categorised into:-

1)      Invasive

2)      Non-Invasive

Invasive Modalities includes:-

·         Atrial Septostomy

Ø  Is a percutaneous procedure by which a right to left shunt is created in the atrial septum allowing decompression of the right side of the heart.

Ø  Atrial Septostomy may improve symptoms, haemodynamics and potentially survival in patients.

Ø  Improvement in functional class, 6- min walking distance and haemodynamic parametes such as cardiac index and right ventricular pressure following atrial septostomy in PAH patients has been reported.

 

·         Right Ventricular Assist Devices

Ø  The placement of a right ventricular assist device (RVAD).

Ø  Evaluation of RVAD flow rate on haemodynamic measures was done. With increasing RVAD speed there was an increase in total pulmonary blood flow, mean pulmonary artery pressure,left ventricular filling pressure and cardiac output as wellas a decrease in right atrial preesure.

·         Pulmonary Artery Denervation

Ø  It involves radiofrequency ablation of sympathetic nerve fibres located at the level  of the main pulmonary artery bifurcation.

Ø  The improvement in haemodynamics and functional capacity shows that PADN might be a promising palliative procedure.

Non-Invasive Interventions include:-

·         Pain control

·         Management of nausea, shortness of breath and anorexia

·         Screening for depression & anxiety

·         Counselling if needed

·         Educating patients about their condition

·         Providing financial assistance/

Information on health insurance coverage

·         Encouraging patients to join support group

 

Patients with PAH and their families experience physical, emotional, social and spiritual distress. With both opioid and non-opioid based therapies , palliative medicine physicians can work with patients towards the goal of living with less pain. Counselling helps patients develop coping skills and reach peace with their new state.

The components of palliative care team are:-

·         Doctors

·         Nurses

·         Family Support

·         Care providers

·         Social workers

·         Pastoral care workers

 

 By implementing these approaches, patient management can be optimised to ensure the best possible outcome for all patients with PAH .Pulmonary Arterial Hypertension remains a fatal disease. Efforts to slow down disease progression are essential and research is ongoing to develop therapies with novel modes of action.

                                                                

Dr. Nividha Chhabra

 

 

 

 

Dental Love Aims to Spread Awareness To Have Healthy Nations as I Believe "Health Is Wealth". Faith, Family,Values,Ethics complete us.Hope Rhymes related to these will inspire u. Happy Reading!!

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