Sophisticated, Personalized Care to Meet Your Needs
Pulmonary hypertension is a rare and serious disease in which blood pressure in pulmonary (lung) circulation is higher than normal. This can cause permanent lung damage and life-threatening heart failure. Patients with pulmonary hypertension need specialist care, like that found at NewYork-Presbyterian. Combining the expertise of pulmonary hypertension experts with the latest technologies and all of the resources available at our two renowned medical centers -- Columbia University Irving Medical Center and Weill Cornell Medicine -- you receive sophisticated, personalized care that is designed to meet your needs and enhance your quality of life.
What is Pulmonary Hypertension?
Pulmonary hypertension is a type of high blood pressure in the lung vessels. This condition affects the arteries in the lungs and right side of the heart, making it harder for your heart to pump oxygen-rich blood. The most common symptoms of pulmonary hypertension include:
- Shortness of breath
- Difficulty exercising
- Chest pain
- Near or complete fainting
- Right-sided heart failure symptoms, including swelling in ankles and legs (edema) and fluid in the abdomen (ascites)
There are several different types of pulmonary hypertension; some are more serious and can become life-threatening. For all patients with pulmonary hypertension, early diagnosis and treatment by expert cardiologists can significantly help improve symptoms and quality of life, as well as reduce the risk of future cardiovascular problems.
A Team Approach to Care
Patients with pulmonary hypertension have complex needs that result from this rare, progressive disease. At NewYork-Presbyterian, our specialists combine their long-term experience in pulmonary hypertension management and heart failure with the latest treatment approaches to provide patients the most advanced care tailored to their unique needs. This team includes cardiologists, pulmonologists, surgeons, interventional cardiologists, rheumatologists and other consultants with expertise in pulmonary hypertension related diseases and complications, as well as critical care anesthesiologists to assist with non-cardiac surgery. You can receive coordinated health care for this complex condition in one medical center. placeholder placeholder placeholder
Here, our expert physicians manage some of the most complicated and sickest patients with pulmonary hypertension.
The Pulmonary Hypertension Association has accredited the Heart Failure and Pulmonary Hypertension Services in the Perkin Center for Heart Failure of NewYork-Presbyterian/Weill Cornell Medical Center and the Pulmonary Hypertension Comprehensive Care Center of NewYork-Presbyterian/Columbia University Irving Medical Center as Tier 1 Pulmonary Hypertension Comprehensive Care Centers. We are the only centers in New York to receive this accreditation and are amongst the first pulmonary hypertension programs in the nation to become accredited.
Expertise in the Dual Management of Pulmonary Hypertension and Heart Failure
Pulmonary hypertension and right heart failure complicate the management of about one-third of the patients with heart failure. At NewYork-Presbyterian, our experienced physicians are trained in both pulmonary hypertension and heart failure, as well as mechanical circulatory support for these conditions. In many cases, right heart failure follows left heart failure, and the management of these difficult cases require a special expertise and understanding of the interdependence of the right and the left heart.
Comprehensive Care for the Most Complex Cases
Our specialists treat all forms of pulmonary hypertension and related right heart failure, including caring for patients with idiopathic (disease of unknown origin) and heritable pulmonary hypertension and those with medical conditions that predispose them to its development. We also treat types of pulmonary hypertension associated with conditions such as:
- Chronic lung disease and advanced lung failure
- Chronic thromboembolic pulmonary hypertension (including surgery for clot removal called pulmonary thromboendarterectomy)
- Congenital heart disease, including Eisenmenger’s syndrome
- Exposure to toxins such as methamphetamines
- Genetic (familial/inherited) pulmonary hypertension
- Hereditary hemorrhagic telangiectasias (HHT)
- Liver disease
- Lupus, scleroderma, Sjogren's and other connective tissue diseases
- Pulmonary hypertension in newborns
- Sickle cell disease, thalassemia, myeloproliferative disease
- Oncological diseases and treatment
We also assist in the management of complex pregnancies with patients who have pulmonary hypertension.
Advancing the Field through Research
Columbia and Weill Cornell clinician-investigators remain at the forefront of research related to pulmonary hypertension. In fact, both Columbia and Weill Cornell clinician-investigators have participated in most of the clinical trials to date evaluating new medical treatments, including the first drug approved for pulmonary hypertension—intravenous epoprostenol—in 1995. Our clinician-investigators continue to pursue studies of newer therapies. Columbia and Weill Cornell are among two of the seven centers participating in an NIH study to precision medicine in pulmonary vascular disease and right heart failure. You may have the opportunity to participate in a clinical trial assessing a promising new treatment.
Columbia and Weill Cornell researchers have long been leaders in the field of genetic discovery in pulmonary arterial hypertension and reported the very first mutation associated with inherited forms of pulmonary hypertension. We collaborate closely with our medical genetics experts to provide genetic counseling and testing for patients and families with inherited forms of pulmonary hypertension.
Ongoing Patient Education and Collaboration
Our doctors and nurses educate and help you and your caregivers about your treatment and life with pulmonary hypertension. We also believe that a collaborative relationship with your referring physician is critical to ensure you receive the best care. Our team also educates other healthcare providers at the local, national, and international levels about advances occurring in pulmonary hypertension care. Our advocacy for support, education, and research directly affects our patients.
How We Diagnose and Treat Pulmonary Hypertension
The early diagnosis, treatment, and long-term management of patients with pulmonary hypertension require a team approach with specialists that have expertise in providing comprehensive and personalized care to patients that meets their individualized needs and maximizes their wellbeing.
If you have signs or symptoms of pulmonary hypertension, you'll have an extensive evaluation by our team of medical and surgical experts.
- Your initial visit will involve a series of diagnostic tests to confirm your diagnosis, assess the severity of your disease, and rule out other causes of your symptoms.
- These tests may include blood testing, electrocardiography, echocardiography with particular RV (right ventricular) focused imaging, cardiac MRI, cardiopulmonary stress testing, lung scans, respiratory function tests, chest CT.
- Most patients need a cardiac catheterization with acute vasodilator and/or provocative testing to customize a plan of care.
Based on the results of your initial assessment, your treatment for pulmonary hypertension may include medical therapies, interventional treatments, surgery, as well as lifestyle recommendations for diet and exercise. Our multidisciplinary team of specialists are experts in identifying the optimal timing of therapeutic interventions according to your individualized needs.
The number of medications for pulmonary arterial hypertension has increased significantly during the past decade. As our understanding of pulmonary hypertension increases, new treatment options are being developed at a rapid pace. All of these treatments are available to our patients as indicated.
- Today, there are oral, inhaled, intravenous, and subcutaneous medications available, and they are often used in combination therapies
- Newer therapies are continuously being investigated
- Conventional therapies include managing manifestations of right heart failure (based on focused imaging); assessing the need for nocturnal, exertional or 24/7 oxygen therapy; and treating ancillary sleep disordered breathing
- Occasionally, a catheterization procedurecalled an atrial septostomy can help pulmonary hypertension patients. By creating a hole in the wall between the upper chambers of the heart, we can permit improved cardiac output while awaiting lung transplantation.
- Balloon pulmonary angioplasty (BPA) may be for patients with chronic thromboembolic pulmonary hypertension who are inoperable, as a hybrid with surgical approaches and in conjunction with medical therapy.
- Newer investigational techniques
At NewYork-Presbyterian, our experienced surgeons collaborate with our highly skilled staff to provide the highest level of care before, during and after surgery. Depending on what type of pulmonary hypertension you have, surgery may help you.
- Pulmonary thromboendarterectomy. If you have chronic thromboembolic pulmonary hypertension, you may be able to have an innovative surgery called pulmonary thromboendarterectomy to clear your pulmonary arteries of clots. NewYork-Presbyterian is one of the few U.S. centers performing this surgery.
- POTTs shunt. For select patients with extremely high pulmonary arterial pressure who are not lung transplant candidates, we can offer a procedure called a POTTS shunt which is a surgical connection between the pulmonary artery and aorta to provide improved cardiac output.
- Lung transplant. Sometimes with pulmonary arterial hypertension, when medication alone is not enough, our patients receive a lung transplant evaluation with our team of lung transplant experts. NewYork-Presbyterian has one of the most active lung transplant programs in the United States, with survival rates surpassing national benchmarks [do we have numbers to support this?]. Our researchers are world leaders looking for ways to eliminate the need for immunosuppression after transplantation.
Our team is committed to giving patients with pulmonary hypertension the tools and resources that will enable them to life the best quality of life. Depending on your individual needs, your long-term care may include:
- Cardiopulmonary exercise testing to identify and follow patients with pulmonary hypertension and heart failure.
- An implanted hemodynamic monitoring system — CardioMEMS -- to remotely monitor and proactively adjust medications in patients with New York Heart Association Class III heart failure who have had a prior hospitalization.
- Nutritional counseling, as well as telephone follow-up by a nurse practitioner who specializes in pulmonary hypertension
- Specialty cardiac catheterization to diagnose and gauge response to treatment (done by our catheterization colleagues)
- Opportunities for participation in multicenter clinical trials as well as ongoing original research