Group 2 Pulmonary Hypertension Treatment & Management

Updated: Jul 30, 2021
  • Author: Nikhil Barot, MD, MS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Treatment

Approach Considerations

Treatment for group 2 pulmonary hypertension consists primarily of treating the underlying left-sided heart disease. Treatment can include pharmacotherapies, surgery, or minimally invasive techniques (valve replacements, bypass grafting, assist devices). [13]

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Medical Care

Medication management is further discussed in Medication.

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Surgical Care

In cases of left-sided sided disease due to valvular disease (aortic or mitral), consideration should be made for referral to a cardiothoracic surgeon for valve repair. For left-sided disease refractory to medical therapy, heart transplantation should be considered.

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Consultations

Referral to a center that specializes in pulmonary hypertension is recommended for further management. With underlying left-sided heart disease, it is recommended to consult with a cardiologist to help with management. In cases of refractory left-sided heart disease, consideration must be made for a referral for cardiac transplantation.

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Diet

Currently, there are no direct guidelines regarding diet for group 2 pulmonary hypertension. However, conservative fluid intake (< 1.5-2 L/day) and avoiding excess salt intake (< 3 g/day) are recommended to prevent exacerbation of left-sided heart disease. Additionally, in cases of left-sided disease due to an ischemic etiology, avoidance of foods high in fats and cholesterol is recommended to prevent further worsening of underlying coronary artery disease.

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Activity

Patients with group 2 pulmonary hypertension can continue to remain active and to partake in physical activity as tolerated; however, very strenuous activity can worsen symptoms.

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Prevention

In cases of left-sided disease due to hypertension, avoidance of high salt intake and optimization of blood pressure can prevent worsening of underlying disease. Additionally, patients should take preventative measures to avoid foods high in cholesterol and fats if the underlying etiology is coronary artery disease. Patients should receive their pneumococcal vaccination and annual influenza vaccination.

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Long-Term Monitoring

Patients should see their pulmonary hypertension specialist regularly. A 6-minute walk test (6MWT) is performed at regular intervals to evaluate functional status. Patients should have a transthoracic echocardiography performed at least annually. A significant change in functional status should prompt a repeat echocardiography and/or right-sided heart catheterization.

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