overview
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