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Chest Pain and Pulmonary Hypertension: Causes and Treatment

Posted on May 17, 2022
Medically reviewed by
Steven C. Pugliese, M.D.
Article written by
Sarah Winfrey

Chest pain is one of the most common symptoms of pulmonary hypertension (PH), along with shortness of breath, fatigue, dizziness, heart palpitations, fainting, and swelling (edema). Although all these symptoms can be distressing, chest pain can be especially troubling for a person with PH and worrying for those who love them.

Angina is a type of chest pain that occurs in people with PH. However, it is important to know that there are many causes of chest pain — some are related to PH and some are not. Any chest pain, no matter what the type or cause, should be evaluated by your physician.

The good news is that treatments for pulmonary hypertension can improve symptoms like anginal chest pain in many people with PH. In this article, we will explore angina-type chest pain caused by PH specifically, including what it feels like and how it is managed and treated.

How Do People With Pulmonary Hypertension Experience Chest Pain?

Many members of myPHteam have experienced chest pain as a result of pulmonary hypertension or pulmonary arterial hypertension. The descriptions of this pain — as well as when it occurs — can vary. Some members find that chest pain is intermittent, whereas others feel their chest pain never completely goes away.

Some say their chest pain tends to correlate with other PH symptoms, such as shortness of breath. Others associate chest pain with certain activities or situations. “Most of us experience chest pain when lifting heavy objects or bending down,” one member explained to another, “so we don't do those things.”

Many find that chest pain is a good indicator that they need to take a break and allow their body to rest. As one member wrote, “I'm feeling really tired and run-down with mild chest pain, so I won’t be doing much today.”

What Causes Chest Pain in Pulmonary Hypertension?

People diagnosed with pulmonary hypertension experience high blood pressure (hypertension) in the lungs. This hypertension particularly affects the pulmonary arteries, which run between the heart and the lungs. In those with PH, the pulmonary arteries may narrow or become stiff and thickened, slowing or stopping the blood flow and, in some cases, leading to chest pain.

The thickening or narrowing of the arteries also makes it more difficult for the heart to pump oxygenated blood throughout the body. As a result, the right side of the heart (which is responsible for pumping oxygen-rich blood) can become overworked and, eventually, damaged. This, too, may cause chest pain.

Managing Chest Pain in Pulmonary Hypertension

A range of strategies can help alleviate chest pain associated with pulmonary hypertension. You and your health care provider can work together to find the right treatment or combination of therapies to address your PH and manage its symptoms.

Note that if you are experiencing new chest pain or chest pain that will not go away, it’s important to talk with your doctor right away.

Medications for Pulmonary Hypertension

A number of different medications may be used to treat pulmonary hypertension. Treating the underlying disease should, in turn, help manage symptoms such as chest pain. Medications commonly used to treat pulmonary hypertension include vasodilators, blood thinners, and diuretics.

Vasodilators

Also called blood vessel dilators, vasodilators help open narrow or blocked blood vessels, including the pulmonary arteries. Your heart will not have to work as hard to pump blood through the widened blood vessels, and you may experience less chest pain.

Anticoagulants

Anticoagulants, or blood thinners, make it easier for blood to flow so that it does not clot in narrowed pulmonary arteries. This may reduce your chest pain.

Diuretics

Diuretics eliminate fluid buildup in the body, and less fluid means less work for your heart.

More types of medications can treat pulmonary hypertension, depending on the type and severity of your case. Talk to your doctor until you find the drug or combination of drugs that works best for you.

Surgery for Pulmonary Hypertension

You and your cardiology or pulmonology teams might consider a number of surgeries, especially if medications aren’t working well for you. Surgical procedures can widen the pulmonary arteries (balloon pulmonary angioplasty), alleviate pressure in the heart (atrial septostomy), and get rid of blood clots (pulmonary endarterectomy). Each procedure can help alleviate PH chest pain, depending on which type of pulmonary hypertension you have.

Adjustments to Activities That Cause Chest Pain

As mentioned by many myPHteam members, certain activities can worsen chest pain. It is best to avoid such activities, if possible. If bending over makes your chest hurt, you may want to talk with your doctor or an occupational therapist about tools to help you reach objects near the ground. That way, you won’t have to bend to pick things up.

If exertion or physical activity causes your chest pain, it may be wise to be supervised by a physical therapist. This type of specialist will work with you to design an exercise regimen that your body can handle. This will help you get the physical activity you need without experiencing undue strain that worsens chest pain. Over time, you may find that your capacity for exercise and exertion improves. You may also experience less chest pain.

Other Healthy Changes

Certain lifestyle changes can help you reduce strain on your heart and manage PH symptoms. You can discuss self-care measures with your health care team.

Quitting Smoking

Cigarette smoking can increase your risk of chest pain. Quitting is one of the best moves you can make to alleviate chest pain and improve your overall health. If you are interested in taking this step, talk with your health care provider about smoking-cessation support or products.

Achieving or Maintaining a Healthy Weight

Obesity is a known risk for high blood pressure, which raises the risk of chest pain. If you are overweight, losing weight can help reduce this risk by easing pressure on your heart and lungs.

Eating a Healthy Diet

Avoid unhealthy fats and excess cholesterol. Your health care provider may ask you to remove as much salt from your diet as possible, too, as this can contribute to water retention.

Learn more about diet and nutrition for PH.

Getting Enough Rest

Rest and sleep will help your body function optimally and counteract some of the fatigue that PH can bring.

Avoiding Factors That Worsen PH Symptoms

Both being at high altitudes (8,000 feet or higher) and performing activities that cause shortness of breath can worsen PH symptoms such as chest pain. Talk with your doctor if you are concerned that a specific factor or activity in your daily life may be worsening this symptom.

Find Your Team

By joining myPHteam, the social network for people with pulmonary hypertension, you can ask questions and share advice with more than 45,000 members who understand life with PH.

Do you experience chest pain as a symptom of PH? How do you manage it? Share your thoughts or tips in the comments below or by posting on myPHteam.

All updates must be accompanied by text or a picture.
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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