Pulmonary hypertension - Symptoms and causes

Pulmonary hypertension – Symptoms and causes – Dr.Sagar

Pulmonary Hypertension
                                                     Pulmonary Hypertension


Pulmonary hypertension-symptoms and causes include blue lips and skin-cyanosis,chest pain dizziness,fainting spells-syncope,e.t.c -all symptoms and causes are described in detail in this article.The  blood  flowing  through the  blood vessels  that  supply  oxygen rich  blood to the  lungs, normally exerts some pressure  on  those blood vessels.
When  this  blood pressure rises  beyond  the  normal range, it is called  pulmonary hypertension .
It  can  increase  the work load  on the heart. It is  a  critical  condition and  can  lead to  heart  failure  and  even  death .
Incidence -Incidence of pulmonary hypertension is one percent of the total population of the world.
Etiology -It  is  common in  individuals  of  75 yrs  old and  higher  age  groups.
Genetic factors  are  also  responsible for  it .
Normal range of  pulmonary  blood  pressure -The  normal  range  of  pulmonary  blood  pressure  is  between  8-20 mm Hg.
If  it  is  more  than  25 mm  Hg  then  it  is  labelled  as  pulmonary  hypertension.
It  can  cause  serious health  problems.

Pulmonary  hypertension is  of  2 types-

1-primary  pulmonary  hypertension
2-Secondary  pulmonary  hypertension
In  primary  pulmonary  hypertension  there  is  no  underlying cause.
It  is  a  rare  condition.
In Secondary pulmonary  hypertension there is  underlying  condition  which  is  responsible  for  pulmonary  hypertension  like  –
a-Chronic  obstructive  pulmonary  disease
b-Congenital heart  diseases .

Symptoms of  pulmonary hypertension –

  • It causes difficulty  in  breathing.
  • As  breathing  is the prime requirement it’s  causes difficultyour  in  talking  answer in  doing  all the routine work.
  • Work  requiring  physical  stress  cannot be done.
  • Its can  cause  fatigue,
  • fainting,
  • dizziness .
  • In early  stages it may  not result in any symptoms at all.
  • So  as we  mentioned  in our  previous  articles routine  check up is  mandatory.
  • Nowadays  people  avoid  doing  any health  check ups.
  • They say  that they are totally  normal.
  • They try to  search  happiness  in  absence of knowledge.

Complications of  pulmonary hypertension –

As purified  ,oxygen  rich blood  arrives in  the  right  side of the  heart  first,it puts lot of  stress  on the  right  side of the  heart  causing right-sided heart  failure.
As a  result  on the  increased  stress on the  right  ventricle  it’s can  cause a  disease  called  right  ventricular  hypertrophy.
Due to  thickened  arterial  wall  there is  occurrence  of  collapse of  the  right  ventricle  due to  which  the  heart  has to  work  more  than  it’s  regular  capacity .The  dimensions of the  ventricle  increase and  the  blood pressure also rises .
This  is life  threatening  complication and  can  result  in  death.
Blood may even  enter the  lungs, causing  haemoptysis and  can  be  lethal.
Arrythmia can  also  occur.
If  any  of  these  symptoms  arises  immediately the  family  me  of  the  concerned  individual  should  make  phone  call  to  an  ambulance  with  oxygen  facility, aperture, minimum  two  ward  boys  to  shift  the  patient  in  hospital  of  a  Cardiologist, or  MD General Medicine doctors.

Etiology of pulmonary hypertension –

  • It  occurs  due to the  thickening  of  the  blood vessels  in  the  lungs.
  • This  causes  narrowing  of the  blood  vessels  in the lungs, thus  reducing  the  volume  of  the  blood  vessels  through  which  the  blood  can flow, this  once the  blood  pressure  and  hence causes pulmonary hypertension .
  • Diseases  of the  connective  tissue  called sclerosis.
  • Congenital  anomalies  of the  heart.
  • BMPR2 gene  mutation
  • Some  toxins, drugs
  • Cirrhosis  of the liver  causing  scarring
  • Kidney  failure
  • HIV  infection
  • Pulmonary  embolism  by  blood  clots
  • Sarcoidosis
  • Sickle cell anemia
  • Metabolic  disorders
  • Aortic  stenosis
  • Heart  valve  diseases
  • Parasitic  infection  by  worms  like  tapeworms
  • Copd
  • Frequenly  climbing to  high  altitudes .
  • Treatment  of pulmonary  hypertension –
  • We  recommend treatment  from  a  qualified and experienced, Chest  physician, or  MD General Medicine specialist doctor.
  • The  doctor  will  do  General  examination,
  • Physical  examination ,
  • Ask  medical  history,
  • family  history,

Investigations  required-

  • Chest  X-ray
  • CTSCAN-Chest
  • MRI -Chest
  • ECG
Right  side  heart  catheterization  to  measure  the  pulmonary  blood pressure
If  the  pulmonary blood pressure is  more  than  25 my Hg  at  rest  or  more than  30 mm Hg during  exertion, then  it  is diagnosed  as  pulmonary  hypertension.
According to  6 minutes  walk  test  the pulmonary hypertension  is  graded  between  1-4
Stage-1 -In  this  there are no symptoms and  there is no  discomfort  during  exertion
Stage-4 -In this  stage  there are  signs and  symptoms of pulmonary hypertension even at  rest .
This  stage  is  given  the  name of  6 minutes  walk  test  as  this test  determines  as  to  how  much  a  patient of  pulmonary hypertension  can walk  in 6 minutes and  what  is  the  response  of  body  to  this  activity.
Depending  on  the  response  of  this  6 minutes  walk  test  ,further  treatment  is  planned  by  doctors.
Treatment  of  pulmonary hypertension –
  • Treatment  depends  on  the  underlying  cause.
  • The underlying  cause  should be  treated.
  • Associated  medical conditions  should  also be  treated.
  • Treatment  also  depends  on  the  grading  of  pulmonary hypertension  according to the  6 minutes  walk  test.
  • Patient  is  asked to  do  mild  exercises  like  walking
  • Walking  will  improve  the physical  quality  of  exertion. This  is  not  advisable  in  severe  cases  but  only in  mild  cases.
  • Admission  to  hospital and administration  of  Oxygen.
  • Those who  climb high  altitudes  should  take  oxygen  cylinders  with  them.

Drugs  for  pulmonary hypertension –

  • Diuretics -these  reduce fluid  retention and  oedema in the  tissues  by  excretion  of  water and salts  in  urine .
  • Digoxin -this is  used  in heart  failure  which  increases  the amount of  blood  pumped  by the  heart
  • Blood  thinners  like  warfarin  which  reduce  the  risk of  formation of  blood  clots.
  • Calcium  channel  blockers -Diltiazem which  causes  vasodilation by relaxation  of the  smooth  muscles in the  blood  vessels and  thus  increase in  blood  flow.
  • Phosphodiasterase inhibitors  like  Sildenafil  which  increase the  blood  flow by  increasing the diameter of the  blood vessels.
  • Endothelial  receptor antagonist like  bosentan  which  cause limitation in the constriction  of the  arteries .
  • Inhalations of  opioids  like  iloprost  can  relieve  breathlessness .
  • Surgery -Other  is  opted when there  is  no  relief  by  conservative  methods of  treatment –
  • Atrial  septostomy -In  this  a  shunt  is  placed  between the  chambers  of the  heart to  increase  there  cardiac  output.
  • Lung transplant.
  • Combined  heart-lung transplant
  • Thromboendarterectomy-this is  done  to remove blood  clots  in the coronary  arteries.
  • At present  there  is  no  satisfactory  treatment  available  for  pulmonary hypertension


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