What is Pulmonary Hypertension?
It is defined as the increased pressure in the pulmonary vessels such as pulmonary artery, vein or capillaries together known as lung vasculature, leading to dyspnoea, dizziness, fainting and other symptoms which are exaggerated by exertion.
In simple language it is a kind of high blood pressure that affects the arteries in the lungs and right side of your heart.
Pulmonary hypertension begins as a result of narrowing or blockage or destruction of small arteries of lungs called as pulmonary arteries and capillaries. Due to this narrowing it becomes difficult to pass blood through lungs and due to this pressure in lungs arteries increases. As the pressure increases, heart’s right ventricle has to work harder to pump the blood through lungs and subsequently heart muscles become weakened and eventually fail.
Which sex and age group are usually affected?
Pulmonary hypertension is seen in females more as compared to males.
Younger women at especially who are at child bearing age are at higher risk of developing pulmonary hypertension.
Older age people are more susceptible to develop secondary pulmonary hypertension.
Which race is usually affected?
Any race can be affected by this condition of pulmonary hypertension.
What are the risk factors involved in Pulmonary hypertension?
Risk factors for development of pulmonary hypertensive disease are as follows.
• Age: Individuals older age group are more susceptible to develop secondary pulmonary hypertension. However, young people are more susceptible to develop idiopathic or primary pulmonary hypertension.
• Family history: Pulmonary hypertension shows family history. Genes can lead to overgrowth of cells in the small arteries of your lungs making them narrow.
What are the causes of Pulmonary Hypertension?
Pulmonary hypertension caused due other underlying medical problems is known as secondary pulmonary hypertension.
And the causes for secondary pulmonary hypertension are as follows:-
• Chronic pulmonary obstructive disease such as emphysema.
• Connective tissue disorders:- scleroderma or lupus.
• Sleep apnea and other sleep disorders.
• Congenital heart defects.
• Sickle cell anemia.
• Chronic liver disease especially cirrhosis.
• Blood clot in lungs.
• AIDS
• Left side heart failure.
• Living at high altitudes higher than 8,000 feet.
• Prolonged Usage of certain stimulants and drugs, such as cocaine.
• Lung diseases such as pulmonary fibrosis, a condition that causes scarring in the tissues between the lungs’ air sacs.
Elaborate the signs and symptoms of Pulmonary Hypertension?
Pulmonary hypertension presents the following symptoms:
• Fatigue.
• Dizziness or fainting spells (syncope).
• Pitting oedema in ankles, legs and eventually swelling in your abdomen.
• Chest pressure or pain.
• Exertion Dyspnoea, initially and then dyspnoea even while at rest
• Bluish color to lips and skin.
• Racing pulse or heart palpitations.
Signs of physical examination are as follows:
• Pulmonary hypertension.
• Including a loud S2.
• Sterna heave.
• Jugular venous distension.
• Pedal edema.
• Ascites.
• Hepatojugular reflux.
• Clubbing.
What are the investigations of Pulmonary hypertension?
First of all physical examination show following features:
• Altered heart sounds.
• Pulmonary valve closure sound.
• Elevated jugular venous pressure.
• Peripheral edema.
• Hepatojugular reflex.
• Clubbing.
Blood tests to be done are:
• Complete blood count.
Imaging:
-X-ray chest.
-Doppler echocardiogram.
-Trandesophageal echocardiogram.
-Right heart catheterization.
Other tests done are as follows:
• Pulmonary function test.
• Perfusion lung scan.
• Computerized tomography.
• MRI of lungs.
• Open lung biopsy.
Genetic tests to detect gene defects.
What are the Complications of Pulmonary Hypertension?
• Right-sided heart failure.
• Blood clots.
• Arrhythmia.
• Bleeding.
• Pedal edema.
• Pleural effusion.
• Ascites.
• Worsening dyspnea upon exertion.
• right side heart failure( advanced) with liver or hepatic congestion.
What are the Deferential Diagnosis of Pulmonary Hypertension?
• Sleep apnea.
• Mixed connective tissue disease.
• Portal hypertension.
• Pulmonary hypertension, secondary.
• Pulmonary stenosis.
• Scleroderma.
• Systemic lupus erythematous.
• Hypothyroidism.
• Dilated cardiomyopathy.
• Mitral stenosis.
• Scleroderma.
What is the prognosis of Pulmonary Hypertension?
In Neglected cases of Pulmonary Hypertension it lead to cor pulmonale which is right ventricular failure.
Surgical procedures that help are:
• Atrial septostomy.
• Lung transplantation.
• Pulmonary thromboendarterectomy
