Pulmonary Hypertension

Pulmonary Hypertension (PH)

Pulmonary Hypertension an unusual lung disease that occurs when the arteries become narrow and tough which carries blood from the heart to the lungs. The thinness and confinement of arteries make it difficult for blood to seep through the vessels. Resultantly, the blood pressure in these pulmonary arteries rises far above normal levels leading to enervating and broadening the right ventricle of the heart. The right ventricle slowly becomes weaker and fails its power to pump sufficient blood to the lungs. This could lead to right heart failure. 

PH occurs in people of all generations, age groups, ethnicity, and locality; although it is much more common in young grown-ups and is nearly double as popular in women. In a small segment of people, PH slowly and gradually becomes worse and life-threatening. However, the treatment of PH at right time and right pace can reduce the symptoms and improve the quality of life. 

Symptoms of PH

The symptoms mainly include the following:

  • Chest pain
  • Difficulty in breathing (even with normal movements such as climbing stairs, running, etc.)
    • Fatigue 
    • Dizziness or fainting spells 
  • Passing out
  • Swelling in the ankles, abdomen, or legs 
  • Bluish lips and skin
  • Irregular heart rate  or fast pulse rate

Possible Reasons for Pulmonary Hypertension (PH)

  • Congestive heart failure 
  • Liver diseases, rheumatic disorders
  • Lupus, scleroderma, rheumatoid arthritis, and other autoimmune diseases
  • Blood clots in the lungs 
  • HIV
  • Drug usages such as cocaine or methamphetamine
  • Lung diseases 
  • Sleep Apnea
  • Heart diseases such as aortic valve disease, mitral valve disease, left heart failure, and congenital heart disease
  • Low oxygen condition
  • Genetics: PH is inherited in a minor amount of cases. 

Risk factors

Pulmonary hypertension can be diagnosed in any age group but it is more often found in people having 30 to 60 years of age. As you get older, the risk of suffering from pulmonary arterial hypertension (PAH) will increases. However, idiopathic PAH is more common in younger adults.

There are some other conditions and factors that can escalate the risk of pulmonary hypertension such as:

  • A family history of the PH.
  • Access to body weight.
  • Blood clots in lungs.
  • Exposure to asbestos.
  • Congenital heart disease.
  • Living in hilly areas.
  • Usage of weight loss drugs.
  • Illegal drug usage such as cocaine.
  • Use of selective serotonin reuptake inhibitors (SSRIs) to treat depression and anxiety.

Complications

Following are the potential complications of pulmonary hypertension:

  • Right-sided heart enlargement and heart failure (cor pulmonale): In pulmonary hypertension, the heart’s right ventricle becomes extended and finds difficulty in pumping blood and its circulation through narrowed or blocked pulmonary arteries.

Due to this, the heart walls thicken and the right ventricle enlarged to hold more amount of blood in it. These all variations create pressure on the heart and lead to the failure of the right ventricle.

  • Blood clots: Pulmonary hypertension increases the risk of blood clots in the small arteries in the lungs.
  • Arrhythmia (irregular heartbeats): Pulmonary hypertension can cause life-threatening heart palpitations, dizziness, or fainting.
  • Bleeding in the lungs. PH can lead to deadly lung bleeding and coughing up blood.
  • Pregnancy complications. Pulmonary hypertension can adversely affect the baby’s development and growth in the mother’s womb.

Diagnosis of Pulmonary Hypertension

To diagnose the presence of pulmonary hypertension, following numerous medical and physical examinations are required;

Physical Test:

During a physical examination, the doctor will examine the;

  • Irregular and unusual heart sounds such as loud pulmonic valve sound, a systolic murmur of tricuspid regurgitation, or a gallop due to ventricular failure.
  • The jugular vein in the neck for enlargement.
  • Abdomen, legs, and ankles for fluid retention.
  • needs for bluish stain.
  • Symptoms of other diseases that might be causing pulmonary hypertension.
  • Blood tests: Following blood tests are required to diagnose the pulmonary hypertension of an individual;
    • Complete metabolic panel (CMP) to examine the liver and kidney function.
    • Autoantibody blood tests, such as ANA, ESR screen the collagen vascular diseases.
    • Thyroid-stimulating hormone (TSH) to screen for thyroid problems.
    • HIV test
    • Arterial blood gases (ABG) to determine the level of oxygen in arterial blood.
    • Complete blood count (CBC)
    • B-type natriuretic peptide (BNP) to examine heart failure.
  • Doppler echocardiogram uses sound waves to examine the heart’s functioning. 
  • Chest X-ray depicts the enlarged right ventricle and pulmonary arteries.
  • 6-minute walk test to examine the exercise tolerance level and blood oxygen saturation level during exercise.
  • Pulmonary function tests to examine the lung conditions.
  • Polysomnogram or overnight oximetry to screen for sleep apnea.
  • Right heart catheterization measures the heart pressures, heart blood pumping rate, and traces any gaps between the right and left sides of the heart.
  • Ventilation-perfusion scan (V/Q scan) finds out the blood clots in the veins flowing from the heart to lungs.
  • A pulmonary angiogram looks for blood clots or blockages in the pulmonary arteries.
  • Chest CT scan: Looks for blood clots and other lung conditions.

When should I visit the Doctor about Pulmonary Hypertension?

You should immediately visit the doctor if you are having the following problems:

  • Weight gain — 2 pounds in one day or 5 pounds in one week
  • Swelling in ankles, legs, or abdomen
  • Irregular breath
  • Extreme fatigue 
  • Worst respiratory infection or a cough 
  • Fast heart rate (around 120 beats per minute)
  • Episodes of chest pain or discomfort with exertion that are not relieved with rest
  • Difficulty in breathing during regular activities or at rest
  • Restlessness, confusion
  • Constant dizziness or lightheadedness
  • Nausea or poor appetite

Possible treatment of Pulmonary Hypertension 

Before initiating any treatment for pulmonary hypertension, the Doctor will diagnose the actual problem and its related cause to recommend the treatment accordingly, but generally following treatments can be taken;

  • Medications
  • Inhaled medicine
  • Medicine is given  through the veins under the skin
  • Medicine to reduce swelling
  • Oxygen therapy
  • Changes in lifestyle and diet
  • Having surgery (if necessary)
  • Visit your doctor regularly to monitor the improvements

References:

 

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