Potential of a hidden Pulmonary Hypertension Epidemic
What is Pulmonary hypertension?
Blood is pumped from the right side of the heart, through the lungs to collect oxygen and release carbon dioxide. The artery through which this blood flows to the lung is called the pulmonary artery.
Pulmonary hypertension is high blood pressure in the blood vessels that supply the lungs (pulmonary arteries). It's a serious condition that can damage the right side of the heart. The walls of the pulmonary arteries become thick and stiff, and cannot expand as well to allow blood through.
What are the symptoms?
tiredness
feeling faint or dizzy
chest pain (angina)
a racing heartbeat (palpitations)
swelling (oedema) in the legs, ankles, feet or tummy (abdomen)
The symptoms often get worse during exercise, which can limit your ability to take part in physical activities.
Further information from the NHS Website >
Why am I concerned about this condition that is not very common?
Based on our autoimmune research, it would be anticipated that previous moderate to severe COVID-19 infection and/or covid vaccination could trigger autoantibodies to ACE-2 which is the entry receptor for the virus, and binds strongly to viral and vaccine spike protein.
Read our Frontiers Paper here >
High concentrations of ACE-2 receptors are present on the endothelial lining of the pulmonary circulation, and autoimmune damage (ACE-2 autoantibodies) to these blood vessels could increase the risk of pulmonary hypertension.
This prediction on pulmonary hypertension may occur gradually over a number of years, and like a storm surge, overwhelm the limited resources available for patients.
Could this also be a contributing factor to the rising cases of sudden death?
“Pulmonary arterial hypertension (PAH) is a devastating disease, leading to right ventricular (RV) heart failure and death. Two decades ago, the median survival rate from diagnosis, despite the available supportive treatment…”
”Sudden cardiac death is now encountered more often in PAH patients…”
Demerouti, Eftychia A., et al. "Complications leading to sudden cardiac death in pulmonary arterial hypertension." Respiratory Care 58.7 (2013): 1246-1254.
Sadly pulmonary hypertension is not a straightforward diagnosis and remains difficult to treat.
What could be done differently if ACE-2 autoimmunity was accepted by the scientific community?
Screen patients in high risk groups for ACE-2 autoantibodies. This would include the usual risk factors for severe COVID-19, older patients (over 55 years) and long Covid sufferers. Important to note that this investigation is not standard for most clinicians.
If autoantibodies are present, do a baseline echocardiogram specifically looking at pulmonary pressures. They could need annual or 2 yearly monitoring.
Consider immunosuppression in some patients with high autoantibody titres.
Develop more options for treatment in anticipation of future greater demand.
Another challenge for the medical fraternity to overcome.
What is the test for ACE-2 autoantibodies called or how is it done? How specific and sensitive is it?