The benefit of using a low dose calcium channel blocker in a patient with idiopathic pulmonary hypertension

Introduction: Pulmonary arterial hypertension is defined by hemodynamic and pathophysiological changes of increased resting mean pulmonary arterial pressure ≥ 25mmHg estimated by right heart catheterisation. Case report: We describe a 44-year-old woman who presented for evaluation 13 years after being diagnosed with primary pulmonary hypertension. Over that extended period of time, she did not develop any changes in her coronary or pulmonary vascular measurements as documented by repeat catheterization. She did not have signs of systemic connective tissue disease. Throughout this time, she was managed with continuous medical treatment of low-doses of a Ca-channel antagonist (nifedipine 10mg twice per day) along with oral anticoagulant therapy. Her ongoing complaints were of fatigue when engaged in heavy physical activity, but there was no progression of symptoms. She also occasionally felt symptoms of increased heart rate and syncope. Auscultation revealed a systolic murmur along the left parasternal edge and an accented second sound of the pulmonary artery. Electrocardiography showed sinus rhythm and incomplete right bundle branch block. Echocardiography was consistent with signs of pulmonary hypertension. Conclusion: A small number of patients with pulmonary hypertension have a good prognosis with treatment with modest doses of calcium blockers as seen in our patient who has had a stable course of disease for many years.