Pulmonary hypertension

What is pulmonary hypertension?

Pulmonary hypertension is a type of blood pressure that affects the arteries of the respiratory system and lungs, as well as the right side of the heart. It is a serious condition, as the blood vessels that carry blood from the heart to the lungs – the pulmonary arteries – become narrowed, hardened, blocked or even destroyed.

At higher pressure, the right ventricle, located in the lower chamber of the heart, needs more work to be able to pump blood, causing the heart muscle to gradually begin to weaken and eventually fail.

Pulmonary hypertension can be classified by stages:

  • Class I: despite the diagnosis, the patient has no symptoms with normal activity.
  • Class II: the patient has no symptoms at rest, but does notice some symptoms during activity.
  • Class III: the patient is comfortable at rest but has symptoms when physically active.
  • Class IV: the patient has symptoms when physically active and at rest.

Pulmonary hypertension can cause complications, such as:

  • Enlargement of the right side of the heart, causing heart failure.
  • Blood clots
  • Arrhythmias
  • Bleeding

Prognosis of pulmonary hypertension

The prognosis of pulmonary hypertension varies depending on the severity of the condition. In some stage III and stage IV cases, the disease can become fatal.

It is an incurable disease, although there are treatments that help to mute the symptoms and improve the sufferer’s quality of life.

It should be noted that in recent years progress has been made in the treatment of the disease, with the development of new treatments that have proven to be more effective in combating the disease, improving the quality of life of those affected and extending their life expectancy.

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Early detection of the disease is essential for early diagnosis.

Symptoms of pulmonary hypertension

In many cases, the symptoms of pulmonary hypertension appear or manifest themselves when there is advanced damage. Thus, the signs of the disease may not be visible for months or years, so the role of primary care is essential for early diagnosis of the disease. As the disease progresses, symptoms worsen.

The main symptoms of pulmonary hypertension are as follows:

  • Dyspnea: shortness of breath while exercising and while resting.
  • Fatigue
  • Chest pressure
  • Chest pain
  • Dizziness
  • Fainting spells (syncope)
  • Swelling in the ankles and legs, and eventually in the abdomen
  • Cyanosis — bluish color of the lips and skin
  • Rapid heart rate
  • Lack of appetite

Medical tests for pulmonary hypertension

Diagnosing pulmonary hypertension is difficult because sometimes the disease does not become apparent until it is advanced. Several tests are available to diagnose the disease:

  • Echocardiogram
  • Chest X-ray
  • Electrocardiogram
  • Right heart catheterization
  • Blood tests

In turn, in order to check the condition of the patient’s lungs, there are other tests to observe the condition of the affected organs and to determine the cause of the disease.

  • Computed tomography (CT) scanning
  • Magnetic resonance imaging (MRI)
  • Pulmonary function test
  • Polysomnography
  • Ventilation/perfusion scan
  • Open lung biopsy

Genetic testing

In the event that a family member has had pulmonary hypertension, the physician may test for the genetics associated with hypertension. If the result is positive, the physician may recommend that other family members be tested.

Pulmonary hypertension occurs when the pulmonary arteries become clogged, stiffened or blocked.

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What causes pulmonary hypertension?

The heart has four chambers: the two upper chambers, called the atria, and the two lower chambers, the ventricles. When blood passes through the heart, the right ventricle pumps blood to the lungs through the pulmonary artery.

In the lungs, the blood removes carbon dioxide and retains oxygen, passing this oxygenated blood through the blood vessels in the lungs to the heart.

In cases of pulmonary hypertension, changes occur in the cells lining the pulmonary arteries, hardening the walls or forming additional tissues that can block them.

These changes can block or reduce blood flow, raising blood pressure in the pulmonary arteries.

Depending on the cause, pulmonary hypertension is classified into five groups:

  • Group 1: Pulmonary arterial hypertension.
    • Unknown cause, known as ideopathic arterial hypertension.
    • Mutation of specific gene, hereditary pulmonary arterial hypertension
    • Medications or drugs such as methamphetamines
    • Congenital heart disease
    • Connective tissue disorders, HIV infection and chronic liver disease, cirrhosis.
  • Group 2: Pulmonary hypertension caused by left-sided heart disease
    • Left-sided heart disease of the left valve; mitral or aortic valve
    • Left inferior cardiac cavity insufficiency
  • Group 3: Hypertension caused by pulmonary disease
    • Chronic obstructive pulmonary disease, emphysema
    • Pulmonary disease, pulmonary fibrosis
    • Sleep apnea
  • Group 4: Pulmonary hypertension caused by chronic blood clots
    • Embolism
  • Group 5: Hypertension associated with other conditionsBlood disorders
    • Sarcoidosis
    • Metabolic disorders
    • Tumors that press on the pulmonary arteries
  • Eisenmenger’s syndrome and pulmonary hypertension

This is a congenital heart disease that causes pulmonary hypertension. There is a large hole between the ventricles that causes blood to circulate abnormally.

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Can high blood pressure be prevented?

Pulmonary hypertension appears without warning, even years after having it when the disease is in an advanced stage. Thus, there is no specific way to prevent the onset of hypertension, although risk factors can be avoided:

  • Avoid being overweight
  • If there is a family history of hypertension, contact a specialist.
  • Diseases that increase the risk of hypertension.
  • Consumption of illegal drugs, such as cocaine.
  • Medications such as appetite suppressants

Treatments for pulmonary hypertension

As such, pulmonary hypertension is an incurable disease, although specialists can help the patient treat and control the disease, improving the symptomatology and slowing the progression of the disease.

  • Medications for pulmonary hypertension
    • Blood vessel dilators
    • Anticoagulants
    • Diuretics
    • Digoxin
    • Oxygen
    • Endothelin receptor antagonists
    • Sildenagil and tadalafil
    • High doses of calcium channel blockers
    • Soluble guanitalate cyclase stimulator
  • Surgeries
    • Atrial septostomy: consists of an opening between the upper chambers of the heart to relieve pressure. It can lead to serious complications, such as arrhythmias. It is performed when drug treatment does not work.
    • Transplantation: there are cases in which heart or lung transplantation is an option, especially in young people with idiopathic pulmonary arterial hypertension.

Which specialist treats pulmonary hypertension?

The specialists in charge of treating pulmonary hypertension are cardiologists, whether or not they specialize in minors, as well as cardiac surgeons.

Pneumology specialists are also professionals who can treat this disease, although more from a diagnostic perspective.