Pulmonary arterial hypertension (PAH)

Symptoms

What are the symptoms of pulmonary arterial hypertension

The symptoms for all types of pulmonary hypertension (PAH) may be similar, and symptoms are usually more severe as the disease progresses. Symptoms of PAH may include:

• Breathlessness
• Chest pain (also called angina pectoris)
• Dizziness
• Fainting (also called syncope)
• Loss of energy (also called fatigue)
• Swelling of the arms, legs, ankles or abdomen (also called edema)
• Dry cough
• Raynaud’s phenomenon (chalky white or dusky blue fingers that may be painful and can sometimes be provoked by the cold)

In advanced stages of PAH, minimal activity may produce some or all of these symptoms. Patients in advanced stages may experience irregular heartbeat, a racing pulse, passing out and difficulty breathing at rest. Sometimes these symptoms mean you have another condition, but sometimes, these symptoms mean you have PAH.1

How is it diagnosed

PAH can be difficult to diagnose in a routine medical exam because the most common symptoms of PAH, such as breathlessness, fatigue and dizziness, are also associated with many other conditions. If your doctor suspects that you have PAH, he or she will want to review your medical and family history, perform a physical exam and perform one or more diagnostic tests.

Preliminary Tests

To determine if you have PAH, and what type, your medical team will schedule specialized tests. If your medical team suspects PAH as a result of one or more of the following tests, they will go on to schedule a right-heart catheterization, which is required to confirm diagnosis.

Blood Tests

Blood tests check the oxygen levels in the blood, they observe liver and kidney function, and they identify whether the patient has collagen vascular disease, thyroid problems, signs of infection or HIV antibodies. One test, the brain natriuretic peptide, helps to assess the strain on the heart and may also be used to monitor response to treatment.

Chest X-Rays

Chest X-rays can reveal an enlarged right ventricle or pulmonary arteries. Chest X-rays can also show signs of emphysema or scarring (interstitial fibrosis) of the lungs.

Electrocardiogram (ECG)

An electrocardiogram checks the electrical impulses of the heart. Electrodes are attached to the patient’s skin, and a recording of these impulses is made. However, an ECG alone is not enough to indicate a PAH diagnosis. If your doctor performs an ECG, he or she will also perform one or more additional procedures to identify PAH.

Echocardiogram

In this procedure, electrodes are placed on the patient’s skin, and a sonogram of the heart is taken. This painless procedure is often used to make a preliminary diagnosis by estimating the pressures in the right heart and assessing how well the heart is functioning. Other heart conditions that produce symptoms similar to PAH may be diagnosed with an echocardiogram. In addition, an echocardiogram may be used to monitor a patient’s condition.

Pulmonary Function Tests

These tests measure how much air your lungs can hold, how much air moves in and out of them and the lungs’ ability to exchange oxygen. These tests may be performed to potentially identify its cause.

Exercise Tolerance Test (Six-Minute Walk Test)

During this test, a patient will be asked to perform an exercise, most commonly a six-minute walk. The purpose is to identify the patient’s exercise tolerance level.

Nuclear Scan (Ventilation/Perfusion Scan or V/Q Scan)

This diagnostic tool tests for blood clots in the lungs by producing a picture of air and blood flow to the lungs. A small dose of radioactive material is breathed in and another small dose is injected via a blood vessel into the lungs. The doctor will review the images that are produced to evaluate the health of the lungs.

The Gold Standard for PAH Diagnosis

Right-Heart Catheterization

If the results of initial tests point to PAH, your doctor will schedule a right-heart catheterization (commonly referred to as a “right heart cath”). Right-heart catheterization is one of the most accurate and useful tests to get a definitive diagnosis for PAH. This is the only test that directly measures the pressure inside the pulmonary arteries, and it should be done in all patients at least once to confirm a patient’s diagnosis of PAH. During the test, doctors insert a catheter (a thin rubber tube) through a large vein in the patient’s groin or neck. They then pass the catheter up into the patient’s heart to measure the blood pressure in the right side of the heart and lungs.

Vasodilator Study (Acute Vasodilator Challenge)

This test is used for patients who have already been diagnosed with PAH to determine how much their pulmonary blood vessels can relax over a brief period of time. Its main purpose is to screen for patients who might respond favorably to calcium channel blockers, a form of medication. The test can also help determine the patient’s prognosis. With a right heart catheter in place, the patient is given drugs that relax the pulmonary arteries. The test drug is given to the patient in higher and higher doses, pausing at each dose to see how the patient reacts. Once a significant response occurs or the side effects become intolerable, the test is considered complete.2

Medications

Pulmonary Arterial Hypertension Medications

While there is currently no cure for PAH, different treatment options are available to help you manage your disease and feel better day-to-day depending on your type of PAH. Your doctor may prescribe medication as part of your treatment. The following specialty medications are available at Accredo for the treatment of PAH.

Financing Your Care

Financial assistance coordination may be available to support your drug costs including manufacturer and community programs. You may also use the copay assistance search for additional programs. Accredo representatives are available to help you find a program that might work for you 866-344-4874.

Community financial resources

• Caring Voice Coalition (CVC)
• Good Days
• PSI-Patient Services, Inc.
• Pan Foundation (IPF only, not PH)
• Flolan (epoprostenol) GSK manufacture assistance
• Adcirca (tadalafil) United Therapeutics manufacturer assistance
• Adempas (riociguat) Bayer manufacturer assistance
• Letairis (ambrisentan) Gilead manufacturer assistance
• Opsumit (macitentan) Actelion manufacturer assistance
• Orenitram (oral treprostinil) United Therapeutics manufacturer assistance
• Remodulin (intravenous treprostinil) United Therapeutics manufacturer assistance
• Revatio (sildenafil) Pfizer manufacturer assistance
• Tracleer (bosentan) Actelion Pathways
• Tyvaso (inhaled treprostinil) United Therapeutics manufacturer assistance
• Uptravi (selexipag) Actelion Pathways
• Veletri (epoprostenol) Actelion Pathways
• Ventavis (iloprost) Actelion Pathways

Financial Guidance

Life-saving specialty medication can be expensive. Learn how the Accredo teams help individuals find ways to afford the medication they need to survive in this video.

Find Support

Accredo Health Group, Inc. (Accredo), along with other patient-focused organizations, support and care for individuals living with pulmonary arterial hypertension (PAH) and their caregivers. In addition, they are dedicated to research and advocacy for PAH patients. See below for information about Accredo’s clinical support model and a few of our partner organizations.

Support organizations

• Pulmonary Hypertension Association
• PHAware
• National Heart, Lung, and Blood Institute (NHLBI)
• National Organization of Rare Disorders (NORD)

Government organizations

• Centers for Medicare and Medicaid
• Medicare
• Food and Drug Administration for patients
• The Voice of the Patient – Pulmonary Arterial Hypertension - A series of reports from the U.S. Food and Drug Administration’s (FDA’s) Patient-Focused Drug Development Initiative

Meet the Team

When you choose Accredo, you receive individualized treatment as prescribed by your doctor and focused attention from your clinical support team. Learn about our various clinical teams dedicated to the 24/7 care and support of PAH patients and caregivers.

Nurses

Accredo’s home infusion and telephonic nursing teams support patients and their caregivers through therapy administration, education and training, plus counseling for issues that arise during treatment. We offer assistance that ensures proper care and helps prevent emergency situations.

Pharmacists

Accredo’s team of pharmacists are highly trained in the world of PAH. They review prescriptions for any drug interactions that could happen based on other medications a patient may be taking. They are also available for medication counseling and help coordinate care with prescribers.

Social Workers

The Accredo Wellbeing Watch® program, made up of a team of Accredo-employed licensed social workers, was developed for PAH patients in an effort to care for the whole person. When a person has PAH, it’s not only their physical health that suffers. Living with this disease might also put a strain on their — and their caregivers’ — mental, emotional, social or even financial wellbeing.

Patient Care Advocates

Accredo’s team of patient care advocates stay in close contact with our patients on a regular basis. They help to ensure you have the medication and supplies needed to administer your therapy and manage your condition.

Insurance & Billing Support Representative

The team of insurance and billing support representatives at Accredo are very knowledgeable about the conditions they support and the necessary medication and supplies that are needed to manage the condition. They obtain approvals for your prescription from your insurance company (or payer) before shipping and help explain your insurance coverage.

Why We Do It

Accredo supports patients with chronic and complex conditions and helps them live their best life. Watch our video to learn why we do what we do for our patients.

Why We Do It video transcript

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