Exercised Induced PH
Pulmonary Hypertension is not the same as "regular" high blood pressure or hypertension, which can be easily measured with a blood pressure test.
Pulmonary hypertension is a high pressure in the arteries between the heart and lungs or pulmonary arteries. It is very difficult to detect elevation in pressure in these arteries. Pulmonary Hypertension is a type of vascular disease that can be found in scleroderma patients. (Also see Scleroderma Lung Involvement, What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)
Causes of Pulmonary Hypertension. There are dozens of causes of pulmonary hypertension, ranging from genetics, medications or street drugs, connective tissue diseases (such as scleroderma), heart and lung diseases, and blood disorders. ISN.
Altitude and Hypoxia
|Estrogen and Enzyme CYP1B1
Primary pulmonary hypertension occurs by itself and not secondary to another illness, such as scleroderma. Nailfold capillary examination can easily tell whether pulmonary hypertension is primary or secondary. (Also see Nailfold Capillaroscopy)
Differences in Right Ventricular Functional Changes during Treatment between Systemic Sclerosis–associated Pulmonary Arterial Hypertension (SSc–PAH) and Idiopathic Pulmonary Arterial Hypertension (IPAH). In patients with SSc–PAH, echocardiographic RV function does not improve over time compared with that of patients with IPAH, despite institution of pulmonary artery vasodilator therapies. PubMed, Ann Am Thorac Soc, 2017 May;14(5):682-689.
Secondary Pulmonary Hypertension. When PH occurs along with other lung, heart, or systemic connective tissue disease (such as scleroderma), it is called Secondary Pulmonary Hypertension. The distinction is important because treatments, and their effectiveness, can vary depending upon whether the pulmonary hypertension is primary or secondary. ISN.
|Overview of Secondary PH/PAH
PH Secondary to MCTD
|PH Secondary to Pulmonary Fibrosis
PH Secondary to Scleroderma
PH Secondary to Scleroderma: Dyspnea
Changes in pulmonary exercise haemodynamics in scleroderma (SSc): a 4–year prospective study. Patients with SSc developed mild deterioration of pulmonary exercise hemodynamics and exercise capacity over a 4–year follow–up period, indicating mild but significant progression of pulmonary vascular disease. PubMed, Eur Respir J, 2017 Jul 13;50(1).
Readdressing the entity of exercise pulmonary arterial hypertension (EPAH). Patients with collagen vascular disease, especially scleroderma, are at risk for EPAH and its presence indicates a relatively poor prognosis. PubMed, Respir Med, 2017 Mar;124:65-71.
Influence of Pulmonary Vascular Reserve on Exercise-Induced Pulmonary Hypertension (PH) in Patients with Systemic Sclerosis (SSc). The present study demonstrated that exercise-induced PH was common in patients with SSc. Exercise-induced PH might be closely associated with the factors affecting reduced pulmonary vascular reserve in patients with SSc. PubMed, Echocardiography, 2014 Aug 8.
Impact of pulmonary fibrosis (PF) and elevated pulmonary pressures (PHT) on right ventricular (RV) function in patients with systemic sclerosis (SSc). SSc patients show impaired RV function and both pulmonary fibrosis and PHT are independently associated with RV dysfunction. PubMed, Rheumatology (Oxford),2016 Mar;55(3):504-12. (Also see Cardiac (Heart) Involvement)
Relationship of main pulmonary artery diameter to pulmonary arterial pressure (PH) in scleroderma patients with and without interstitial fibrosis. In scleroderma patients, an enlarged main pulmonary artery predicts PH even in the presence of mild to moderate fibrosis. PubMed, J Comput Assist Tomogr, 2014 Mar-Apr;38(2):163-8. (Also see Correlation of Pulmonary Fibrosis and Pulmonary Hypertension)
Borderline pulmonary arterial pressure (BoPAP) in systemic sclerosis patients: a post-hoc analysis of the DETECT study. In this exploratory post–hoc analysis of the DETECT study population patients with BoPAP could be distinguished from patients with normal mean pulmonary artery pressures and pulmonary arterial hypertension. PubMed, Arthritis Res Ther, 2014 Dec 10;16(6):493.
Evidence-based detection of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc): the DETECT study. The novel, evidence-based DETECT algorithm for PAH detection in SSc is a sensitive, non-invasive tool which minimises missed diagnoses, identifies milder disease and addresses resource usage. PubMed, Ann Rheum Dis, 2014 Jul;73(7):1340-9. (Also see Systemic Sclerosis)
Diagnosis of Pulmonary Hypertension. Doppler echocardiograms are notoriously inaccurate when the PH is mild or when there is simultaneous presence of lung scarring. PH cannot be diagnosed without right heart catheterization. ISN.
DLCO in PH
|Markers for PH in Scleroderma
Right Heart Catheterization
Prognosis of Pulmonary Hypertension. Early diagnosis and treatment substantially improves the prognosis for pulmonary hypertension associated with systemic sclerosis (scleroderma). ISN.
| Overview of PH Prognosis |
Functional Classification of PH
| Markers for Prognosis of PH |
Personal Stories of Prognosis of PH
Treatments include oxygen therapy, Tracleer (bosentan), Digitalis, diuretics, Flolan (in clinical trials), and, in a few cases, heart-lung or double-lung transplants.
Inhaled Prostacyclin (Ventavis, Iloprost)
|PDE 5 Inhibitors
Stem Cell Transplant
Pulmonary Hypertension Research Registries include PHAROS and CoTherix. SureSteps Patient Support Program by Actelion is for patients on Tracleer or Bosentan. ISN.
|PH Research Panel (by WWMR)
PH Registry of Scleroderma (PHAROS)
REVEAL Registry for PH
| Scleroderma Research Registries
Pulmonary Support Organizations
Causes of PH
Pulmonary Hypertension Patient and Caregiver Stories provide vital support, and let others know they are not alone. ISN.
Archie Bailey: Scleroderma: Sue's Story Time has passed since Sue's death. Only those who have experienced the grieving process can understand the profound agony death presents to friends and loved ones…
Bill Jordan: Surviving Boyfriend of Scleroderma Patient Wendy was heartset on dancing that evening even though she was connected to an oxygen machine…
Brother Alan: Systemic Scleroderma I was diagnosed with Scleroderma three years ago and "too many times ten" doctors later, here I am…
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