Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic
Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic |
- Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic
- Echocardiographic Ratio Shows Pre- and Post-Capillary Pulmonary Hypertension - The Cardiology Advisor
- HFpEF With Severe Pulmonary Hypertension Linked to Increased Mortality - Pulmonology Advisor
| Posted: 24 Jun 2019 05:00 AM PDT Most of us could probably stand to dial back our salt intake: According to the American Heart Association, the average American consumes twice the recommended amount per day. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy "Cutting back on salt is important for everyone, even if they do not have a chronic condition like pulmonary hypertension ― but for those that do, it becomes essential," says Mindy Rivera, CNS. Salt mattersWe need to consume at least some sodium ― it helps maintain a normal fluid balance in the body and is essential for muscle function (including the largest and most important muscle ― the heart). But when too much sodium accumulates, the body holds onto water in an effort to dilute it. The amount of fluid surrounding our cells and the volume of blood in the bloodstream also increase, forcing the heart to work harder to pump blood throughout the body. It also puts extra pressure on the blood vessels. Over time, this can increase risk for heart attack, stroke and heart failure. Pulmonary hypertensionIf you have pulmonary hypertension, your heart is already working overtime to pump blood to your lungs through narrowed arteries. "Extra salt intake causes the body to retain more fluid, and therefore further strains the heart to have to pump it through the body," Rivera says. "This can lead to swelling in the legs and abdomen, and worsening shortness of breath." Reducing your sodium intake may help control symptoms and reduce your risk of future heart problems. Sodium vs. saltIt's important to understand that sodium and salt are not exactly the same thing. When most of us use the word salt, we're referring to what we sprinkle on our food. Sodium is the chemical element in salt ― both table salt and sea salt are about 40% sodium by weight.
If you have pulmonary hypertension, your doctor can help you decide how much sodium is appropriate for your diet. Surprise! There's sodium in thereGoing low-sodium doesn't just mean being less generous with the salt shaker. Actually, your best defense is taking a metaphorical magnifying glass to the ingredient labels at the grocery store. "People often mistakenly believe that kicking the salt shaker is the only part of a low-salt diet," Riviera says. "Unfortunately that isn't true; most of our salt intake in America comes already in our foods." And it's in places you might not suspect ― like the chicken you pick up from your grocery store. "Often, fresh poultry has been injected or brined in a salt solution prior to packaging, which can make it a high-sodium food regardless of how carefully you prepare it," she explains. To avoid extra salt, read the packaging for clues like "sodium," "broth" or "saline." Many other foods in your grocer's aisles may be loaded with sodium, too. Check the sodium content before buying items like:
Put a positive spin on itA low-salt diet does not have to be the end of tasty food. In fact, it can be an opportunity to buy less packaged food and experiment with new ingredients, recipes and cooking methods in your own kitchen. It might be hard at first, but over time, your taste will evolve to prefer foods with lower sodium levels (yes, truly ― multiple studies show it). Try jazzing up your food with:
You might have heard about salt substitutes, but check with your doctor before using them ― they could be dangerous for people with certain conditions. It's helpful to keep in mind why making this change to a lower-salt diet is important to you, whether that's to eat healthier or feel less short of breath or stay out of the hospital, Rivera says. "It's also important to recognize that decreasing your salt intake in a sustainable way probably won't happen overnight," she says. "Progress is key."  |
| Posted: 25 Jun 2019 01:00 AM PDT  In patients with pulmonary hypertension (PH), echocardiographic pulmonary to left atrial global strain ratio accurately discriminated between pre-capillary and post-capillary PH, according to a study published in the International Journal of Cardiology. Researchers evaluated the ability of echocardiographic pulmonary to left atrial global strain ratio to differentiate pre-capillary and post-capillary PH to see whether echocardiographic pulmonary to left atrial ratio or echocardiographic pulmonary to left atrial global strain ratio had a superior diagnostic capacity. Patients with unexplained dyspnea or heart failure who were referred for right heart catheterization were included in this study. Transthoracic echocardiography measured left ventricular ejection fraction, wave Doppler measured max tricuspid regurgitation peak velocity, and speckle tracking echocardiography measured left atrial global strain. These measurements were used to calculate echocardiographic pulmonary to left atrial global strain ratio. Right heart catheterization was used to measure mean right atrial pressure and pulmonary artery pressure. Of the 130 patients included in this study, 64 demonstrated pre-capillary PH, 66 demonstrated post-capillary PH, with 39 classified as isolated post-capillary PH, and 27 demonstrated combined post- and pre-capillary PH. When analyzing the baseline characteristics, echocardiographic pulmonary to left atrial global strain ratio was lower in pre-capillary PH than post-capillary PH (0.19 vs 0.45; P =.02), and echocardiographic pulmonary to left atrial ratio was higher in pre-capillary PH compared with post-capillary PH (0.37 vs 0.20; P <.001). Echocardiographic pulmonary to left atrial global strain ratio differentiated between isolated post-capillary PH and combined post- and pre-capillary PH (0.62 vs 0.32; P =.04) and was associated with pulmonary vascular resistance (r =0.28; P =.02) and transpulmonary gradient (r =0.30; P =.01). The diagnostic capability to distinguish pre-capillary and post-capillary PH favored echocardiographic pulmonary to left atrial global strain ratio (area under the curve [AUC] 0.80; 95% CI, 0.72-0.89; P <.001) over echocardiographic pulmonary to left atrial ratio (AUC 0.70; 95% CI, 0.61-0.80; P <.001). Limitations of this study included a lack of standard image acquisition, the absence of a control cohort, potential errors in the variable used to calculate echocardiographic pulmonary to left atrial global strain ratio, and the inclusion of symptomatic patients in the post-capillary PH cohort. The researchers concluded that "[t]he novel [echocardiographic pulmonary to left atrial global strain] ratio distinguishes pre-capillary from post-capillary PH and demonstrates a stronger differentiating capability as compared to [echocardiographic pulmonary to left atrial ratio]." Reference Venkateshvaran A, Manouras A, Kjellström B, Lund LH. The additive value of echocardiographic pulmonary to left atrial global strain ratio in the diagnosis of pulmonary hypertension [published online May 31, 2019]. Int J Cardiol. doi:10.1016/j.ijcard.2019.05.025  |
| HFpEF With Severe Pulmonary Hypertension Linked to Increased Mortality - Pulmonology Advisor Posted: 25 Jun 2019 12:45 AM PDT  Patients with heart failure, severe pulmonary hypertension, and a preserved ejection fraction of ≥50% had a worse prognosis when compared with other patients with heart failure and severe pulmonary hypertension, according to a study published in Heart and Lung. Researchers of this prospective, observational study analyzed The Israeli Association for Cardiovascular Trials database for baseline characteristics, comorbidities, renal and heart status, and long-term prognosis of patients with heart failure and pulmonary hypertension. Using conventional trans-thoracic echocardiograms, patients were categorized by left ventricular ejection fraction into reduced ejection fraction (<40% ejection fraction), mid-range ejection fraction (40%-49% ejection fraction), or preserved ejection fraction (≥50% ejection fraction). Using echocardiography, severe pulmonary hypertension was classified as an estimated systolic pulmonary arterial pressure of ≥50 mmHg. Demographics, echocardiography, and biochemical blood analysis were collected at baseline, follow-up evaluations were completed at 12 months, and mortality rates were assessed at 2 years. Of the 372 patients included in this study, 56% were men, the mean age was 77.3 years old, and the mean duration of heart failure was 6.5 years. The reduced ejection fraction cohort consisted of 159 patients, the mid-range ejection fraction cohort consisted of 50 patients, and the preserved ejection fraction cohort consisted of 163 patients. The reduced ejection fraction cohort was predominantly associated with smokers who had coronary artery disease and renal failure. The preserved ejection fraction cohort was predominantly associated with older women who were obese and had atrial fibrillation. The mid-range ejection fraction cohort did not show patterns in baseline characteristic. Overall, 15% of the patients died by the 2-year mortality rate follow-up. Multivariable analysis indicated New York Heart Association functional class 3-4 (hazard ratio [HR] 2.41; 95% CI, 1.17-4.97; P =.017) and renal failure (HR 2.53; 95% CI 1.45-4.42; P =.001) were independent predictors for mortality. Kaplan-Meier survival curves indicated an association between severe pulmonary hypertension and mortality in the preserved ejection fraction cohort (adjusted HR 2.99; 95% CI, 1.29-6.91; P =.010) but not in the other cohorts. Limitations of this study include only evaluating demographic, clinical, and echocardiographic information from a database, not assessing right heart parameters, and the potential for selection bias. Researchers concluded that patients with heart failure with preserved ejection fraction and pulmonary hypertension "are likely to have different pathophysiology and worse prognosis" and "defining these patients as an independent subgroup may be more appropriate for their management and treatment." Reference Zafrir B, Carasso S, Goland S, et al. The impact of left ventricle ejection fraction on heart failure patients with pulmonary hypertension [published online June 5, 2019]. Heart Lung. doi:10.1016/j.hrtlng.2019.05.006 This article originally appeared on The Cardiology Advisor  |
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