Pulmonary hypertension—abnormally high blood pressure in the blood vessels of the lungs—is a rare but serious disease. Vastly different from essential hypertension, pulmonary hypertension causes the right side of the heart to work harder than normal and can lead to shortness of breath, chest pain, dizziness, fainting, leg swelling and other symptoms.
A chronic disease, pulmonary hypertension affects people of all ages and ethnic backgrounds. Raising awareness in the community and among medical professionals is key to earlier diagnosis and treatment.
“Taking care of people who have pulmonary hypertension requires special expertise, from coordinating their complex medical needs and finding the best drugs to manage their breathing and heart troubles, to obtaining insurance authorization for drug therapies,” says Pulmonary Arterial Hypertension Nurse Navigator Sharon Jones, RN, MSN, CCM.
The pulmonary hypertension program at Christiana Care takes a multidisciplinary approach to treatment, bringing together a pulmonologist, a nurse practitioner, a clinical nurse specialist, a nurse navigator and a clinical pharmacist to provide specialized care for inpatient and outpatient adults. Working together, the team shapes and continually refines an individual plan of care.
In recent years, many new medical treatments have emerged to help patients better manage their symptoms. Pulmonologist Gerald O’Brien, M.D., began treating patients with pulmonary hypertension 19 years ago when he was the director of the lung transplant team at Temple University Hospital.
“In the beginning, there were few treatment options, but now we have medications in all forms—pills, intravenous and subcutaneous infusions, and even inhaled therapies that we can offer. Most patients require triple therapy for the best outcomes, and we strive to reduce the progression of the disease and improve the functional class of our patients,” Dr. O’Brien says.
The outpatient pulmonary hypertension clinic at Christiana Hospital is part of the Center for Heart and Vascular Health. Clinic patients have access to the state-of-the-art cardiac catheterization lab, non-invasive cardiac testing, cardiopulmonary stress testing, pulmonary function lab testing and many other services.
“When patients are admitted, the team works closely with nursing to ensure continuity of care,” Jones says.
Patients on intravenous, subcutaneous or inhaled therapy must be on 3D, the pulmonary stepdown unit, under the care of specially trained nurses. Every nurse on 3D attends an annual pulmonary hypertension workshop developed by the unit’s education council. The workshop was submitted for a Christiana Care Focus on Excellence award, representing the success and dedication of the staff in caring for this unique patient population.
Chanel Etty, a 3D nurse who has taken care of pulmonary hypertension patients for five years, takes pride in having these specialized skills and has seen an increase in pulmonary hypertension patients during this time.
“I find it very rewarding to be a part of a select group of nurses that have expertise in this area,” Etty says. Other program features include a monthly patient-led support group and access to new or investigational treatments through participation in industry-sponsored clinical trials.
Comparing pulmonary hypertension and essential hypertension
|Pulmonary Hypertension||Essential Hypertension|
|High blood pressure in the blood vessels of the lungs||High blood pressure in blood vessels of the rest of the body|
|Gradually increasing shortness of breath, dizziness, fainting or swelling of the legs||Known as the “silent killer” due to lack of outward symptoms|
|Diagnosis often difficult and requires intense diagnostic testing, including echocardiogram, right heart catheterization||Easily diagnosed with serial blood pressure readings|
|Treatment includes pills, intravenous and subcutaneous continuous infusions and inhaled therapy||Treatment includes pills, diet and weight loss|
|Treatment can be obtained in a specialty center with a treatment team of a trained pulmonologist or cardiologist||Treatment can be obtained from a primary care physician, cardiologist or nephrologist|