New Pharmacologic Approaches to Bronchopulmonary Dysplasia ...
Pulmonary Arterial Hypertension
Pulmonary hypertension is a life-threatening condition that gets worse over time, but treatments can help your symptoms so you can live better with the disease. It may take some planning, but plenty of people who have it find ways to do all the things they love, just as they did before they were diagnosed.
Having pulmonary arterial hypertension (PAH) means that you have high blood pressure in the arteries that go from your heart to your lungs. It's different from having regular high blood pressure.
With PAH, the tiny arteries in your lungs become narrow or blocked. It's harder for blood to flow through them, and that raises the blood pressure in your lungs. Your heart has to work harder to pump blood through those arteries, and after a while the heart muscle gets weak. Eventually, it can lead to heart failure.
Sometimes doctors can't find a reason for high blood pressure in the lungs. In that case, the condition is called idiopathic pulmonary hypertension. Genes may play a role in why some people get it.
In other cases, there is another condition that's causing the problem. Any of these illnesses can lead to high blood pressure in your lungs:
You may not notice any symptoms for a while. The main one is shortness of breath when you're active. It usually starts slowly and gets worse as time goes on. You may notice that you can't do some of the things you used to without getting winded.
Other symptoms include:
If you have shortness of breath and see your doctor, they will ask you about your medical history. They may also ask you:
Your doctor may order tests, including:
Echocardiogram: This ultrasound picture of the beating heart can check blood pressure in the pulmonary arteries.
CT scan: This can show enlarged pulmonary arteries. A CT scan can also spot other problems in the lungs that could cause shortness of breath.
Ventilation-perfusion scan (V/Q scan): This test can help find blood clots that can cause high blood pressure in the lungs.
Electrocardiogram (EKG or ECG): An EKG traces the heart's activity and can show whether the right side of the heart is under strain. That's a warning sign of pulmonary hypertension.
Chest X-ray: An X-ray can show if your arteries or heart are enlarged. Chest X-rays can help find other lung or heart conditions that may be causing the problems.
Exercise testing: Your doctor may want you to run on a treadmill or ride a stationary bike while you are hooked up to a monitor, so they can see any changes in your oxygen levels, heart function, lung pressure, or other things.
Your doctor may also do blood tests to check for HIV and conditions like rheumatoid arthritis or lupus.
If these tests show that you might have pulmonary hypertension, your doctor will need to do a right heart catheterization to be sure. Here's what happens during that test:
Right heart catheterization is safe. The doctor will give you a sedative and use local anesthesia. You can usually go home the same day, although you will need someone to drive you home.
You may want to write down a list of questions before your appointment, so you can make sure you ask your doctor everything you want to. It can also help to have a friend or family member with you to help you get the answers you want.
Some possible questions are:
Pulmonary hypertension varies from person to person, so your treatment plan will be specific to your needs. Ask your doctor what your options are and what to expect.
First, your doctor will treat the cause of your condition. For example, if emphysema is causing the problem, you'll need to treat that to improve your pulmonary hypertension.
Most people also get treatment to improve their breathing, which makes it easier to be active and do daily tasks. Oxygen therapy, when you breathe pure oxygen through prongs that fit in your nose, will help if you're short of breath and have low oxygen levels in your blood. It helps you live longer when you have pulmonary hypertension. If you are at risk for blood clots your doctor will recommend blood thinners. Other medicines improve how well your heart works and keep fluid from building up in your body.
If you have severe pulmonary hypertension, your doctor may prescribe medications called calcium channel blockers. These medicines lower blood pressure in the lungs and the rest of the body.
If calcium channel blockers aren't enough, your doctor may refer you to a specialized treatment center. You may need more targeted therapies that can open up your narrowed blood vessels. They may be pills, medicines you breathe in, or drugs that are given through an IV. Options include:
In more severe cases, or if medicines don't help, your doctor may recommend a lung transplant or a procedure called atrial septostomy. A surgeon creates an opening between the right and left sides of the heart. This surgery can have serious side effects.
One of the best things you can do for yourself is to stay active, even if you have shortness of breath. Regular exercise, like taking a walk, will help you breathe better and live better. Talk to your doctor first to find out what kind of exercise is best for you, and how much you should do. Some people may need to use oxygen when they exercise.
Get plenty of rest, too. Pulmonary hypertension makes you tired, so get a good night's sleep and take naps when you need to.
Just like anyone else, it's good for you to eat a healthy diet with lots of fruits, vegetables, and whole grains. That's important for your overall health.
A lot depends on what's causing your pulmonary hypertension. Treating an underlying condition will help you feel better. There's no cure for pulmonary hypertension, but the earlier it's diagnosed, the easier it is to live with.
If you have idiopathic pulmonary hypertension -- the kind where doctors can't find a cause -- your symptoms may get worse over time. But treatment can slow down the progress of the disease and help you live longer.
Remember that each person is different, and there are good treatments available. Work with your doctor to find what's right for you.
The Pulmonary Hypertension Association offers in-depth information on everything from medications to tips on making daily tasks easier. It also has an active online support community.
Vitamins By Condition
Considering taking supplements to treat pulmonary hypertension?Below is a list of common natural remedies used to treat or reduce the symptoms of pulmonary hypertension. Follow the links to read common uses, side effects, dosage details and user reviews for the vitamins and supplements listed below.
Treatment
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Redefining Treatment For Mild Cognitive Impairment
image: Dr. Andreana Benitez (left) of the Medical University of South Carolina urology in the College of Medicine will lead a phase II clinical trial to determine the optimal dose of transcranial magnetic stimulation needed to improve symptoms for patients with depression and mild cognitive impairment. MUSC co-investigators include Dr. Stephanie Aghamoosa (right), Dr. Mark George, and Dr. Lisa McTeague. View more
Credit: Sarah Pack, Medical University of South Carolina
With more than $3.7 million in funding from the National Institute on Aging, Medical University of South Carolina neuropsychologist Andreana Benitez, Ph.D., of the Department of Neurology in the College of Medicine will lead a phase II clinical trial to determine the optimal dose of transcranial magnetic stimulation, or TMS, needed to improve symptoms for patients with depression and mild cognitive impairment, or MCI. In TMS, a magnet is placed against the patient's head and stimulates the brain directly underneath.
Co-investigators include clinical neuropsychologist Stephanie Aghamoosa, Ph.D., of the College of Health Professions, as well as clinical psychologist Lisa McTeague, Ph.D., and psychiatrist and TMS pioneer Mark George, M.D., of the Brain Stimulation Lab within the Department of Psychiatry and Behavioral Sciences. George's work helped TMS to gain approval from the Food and Drug Administration for the treatment of major depressive disorder in 2008.
In this study, the MUSC team will be using intermittent theta-burst TMS delivered in an accelerated treatment course: Participants will choose six TMS treatment days within a two-week period, each lasting about 2 ½ hours. Such an accelerated treatment course could be less burdensome for older adults with MCI.
What is MCI?
MCI is a diagnosis given to those in a predementia state. People with this diagnosis have more than the typical minor forgetfulness of aging but do not yet have the significant memory impairment seen with dementia.
"The clear distinction between MCI and dementia is that those with MCI are still able to be independent," said Benitez. "They may need more time to complete complicated tasks, such as their taxes or finances, but these impairments shouldn't be interfering with their everyday lives. This is certainly not the case with dementia."
People with MCI are more likely to develop Alzheimer's disease or other types of dementia. MCI can have many different causes, including Alzheimer's disease and cerebrovascular diseases, such as stroke-like changes in the brain that are common in aging. Many people living with MCI also have depression, which can also be a risk factor for dementia. It is these people – those with MCI due to Alzheimer's disease or cerebrovascular disease and depression – who will be invited to this study.
The researchers made a special effort to recruit people with MCI from various causes to represent the actual patient base seen clinically. The treatment under study has high potential for addressing various symptoms in a condition known to have varied causes.
Depression and MCI
Depression is common in the older population and especially in those with MCI. When applied to the front left side of the brain, TMS is already approved by the FDA for the treatment of major depressive disorder. The new MUSC study aims to find the optimal dose to improve both depression and thinking difficulties in MCI.
An accelerated treatment approach with a novel form of TMS
Intermittent theta burst, or iTBS, is a novel pattern of TMS: more stimulation pulses are being delivered in a shorter amount of time. Essentially, it's a faster version of TMS. Instead of being administered for 20 to 30 minutes per session, as with traditional TMS, it is delivered in three minutes without losing efficacy.
"Despite this reduction in stimulation time, iTBS has been shown to improve depression as much as traditional TMS and is now FDA-approved for once-daily treatment of depression," explained McTeague. "Because each treatment session is brief, we can deliver multiple sessions of TMS in a single treatment day, meaning that patients can complete in six treatment days what would typically require four to six weeks of once-daily treatment."
In their earlier phase I trial, the researchers determined that this accelerated form of TMS was safe and well-tolerated by patients with MCI, due to either Alzheimer's disease or stroke.
Finding the right dose
In this new phase II trial, the researchers hope to identify the dose of stimulation needed to improve depression and cognition in people with MCI.
"The big issue is that we don't know how much stimulation people need to improve," said Aghamoosa.
To identify the correct dose for each outcome, the researchers will conduct a dose-finding study.
"Some participants are going to be dosed with little to no stimulation all the way up to receiving all active treatment," said Benitez. "We want to see how much we can improve memory and thinking and how much we can improve depression immediately after treatment as well as eight weeks and six months later."
With additional funding provided to Aghamoosa by a discovery grant from the South Carolina Clinical & Translational Research Institute, the researchers will be able to track symptoms by providing Fitbits to participants who opt into this part of the study. Wearable technology, like Fitbits, gives researchers a better grasp on the daily habits of their research participants than does the traditional self-report method. Aghamoosa hopes to use the wearable technology to track how the accelerated treatment affects participants' everyday activities.
This study will be a critical first step in determining if accelerated TMS can help people with MCI and depression.
Once the researchers have identified the proper dose, their next step will be to conduct a multisite pivotal trial to test the efficacy of this treatment in a larger cohort of people with MCI.
"So far, brain stimulation methods like TMS are saving lives and having a big impact in patients with depression, but we have not yet figured out how to use TMS for MCI," said George. "This study will answer important questions that will help us to use these tools to treat patients along the predementia to dementia spectrum."
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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
About MUSC
Founded in 1824 in Charleston, MUSC is the state's only comprehensive academic health system, with a unique mission to preserve and optimize human life in South Carolina through education, research and patient care. Each year, MUSC educates more than 3,200 students in six colleges – Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy – and trains more than 900 residents and fellows in its health system. MUSC brought in more than $298 million in research funds in fiscal year 2022, leading the state overall in research funding. MUSC also leads the state in federal and National Institutes of Health funding, with more than $220 million. For information on academic programs, visit musc.Edu.
As the health care system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest-quality and safest patient care while educating and training generations of outstanding health care providers and leaders to serve the people of South Carolina and beyond. Patient care is provided at 16 hospitals (includes owned and equity stake), with approximately 2,700 beds and four additional hospital locations in development; more than 350 telehealth sites and connectivity to patients' homes; and nearly 750 care locations situated in all regions of South Carolina. In 2022, for the eighth consecutive year, U.S. News & World Report named MUSC Health University Medical Center in Charleston the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.Org.
MUSC has a total enterprise annual operating budget of $5.1 billion. The nearly 26,000 MUSC family members include world-class faculty, physicians, specialty providers, scientists, students, affiliates and care team members who deliver groundbreaking education, research, and patient care.
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