Overview

What is pulmonary hypertension?

Pulmonary arterial hypertension (PAH) is a type of high blood pressure that harms the arteries of the right-hand side of the heart and lungs. In PAH, the blood vessels within the lungs become narrowed, blocked, or damaged. The damage slows the flow of blood to the lungs. The blood pressure in the arteries supplying the lungs rises. The heart has to work more strenuously to pump blood through the lungs. Due to the higher stress, the cardiac muscle deteriorates with time and eventually breaks down.

Aspiratory hypertension can be fatal at times and is worsening progressively. Pulmonary hypertension cannot be cured, but treatments can help increase your quality of life, prolong your life, and improve your well-being.

What are the symptoms of pulmonary hypertension?

The symptoms and signs of pulmonary hypertension offer symptoms. You can fail to notice them for months or even years. In most cases, symptoms present as the disease progresses.

Symptoms of pulmonary hypertension include:

Shortness of breath, initially with exertion and gradually while resting.
Grey or bluish from low oxygen levels due to pale skin color. Skin tone will determine how strong these are.
Episodes of dizziness or syncope.
Accelerated or racing rhythm.
Chest pain or tightness
Drowsiness
Swelling in the abdomen, legs, and ankles.

The most common symptom is breathing difficulty due to pulmonary hypertension. Another medical condition that can cause this is asthma. If you need a precise diagnosis, consult a doctor.

What causes lung hypertension?

An average heart has two upper chambers and two lower chambers. Each heartbeat pumps blood through the lower right chamber to the lungs. The large blood vessel where the blood flows is the pulmonary artery.

The arteries in the lungs, which include veins, vessels, and courses, usually provide a smooth flow of blood to the left side of the heart.

However, changes in the lining cells of the arteries make the walls of the pulmonary arteries thick, swollen, narrowed, hardened, or striped. Pulmonary hypertension may result from these changes slowing down or stopping the flow of blood to the lungs.

According to the underlying etiology, pulmonary hypertension is classified into five types.

Group 1: The first type, also known as PAH-is arterial hypertension (PH)

High blood pressure in the lungs' arteries causes pulmonary arterial hypertension, a narrowing, stiffening, or thickening of the arteries that hinders blood flow. This increased tension further strains the heart as it struggles to pump blood through the arterial supply routes.

In most cases, idiopathic PAH has no known cause. However, its development can also be attributed to other causes, such as:

Hereditary alterations acquired from parents predispose to PAH.
Medications: Besides the cocktail of medicines an individual is on, methamphetamine is one illicit drug that damages the pulmonary arteries.
Congenital heart defects: PAH tends to worsen with heart defects, which are present at birth.
Other medical conditions: Scleroderma, lupus, and cirrhosis increase the chances of having PAH.

Group 2: Patients with left-sided heart disease with PH- The most common class of pulmonary hypertension is in this group. This is due to the failure of the left side of your heart to pump blood to the body to its maximum capacity. As a result, blood floods your heart, increasing the pressure in pulmonary arteries.

Group 3: Pulmonary hypertension due to hypoxia or lung disease-

Hypoxia (low oxygen levels) or lung diseases are causes of Group 3 PH. The blood vessels in the lungs constrict from certain lung diseases, an effect that results in decreased blood flow and increased pressure in the pulmonary arteries.

Group 4 due to blockages in your lungs-

Group 4 PH is caused by blockages in the lungs. These chronic blood clots in the lungs (pulmonary emboli) occur when blood clots or (Tumors blocking the pulmonary artery), scars from previous blood clots obstruct normal blood flow through the lungs. The increased pressure on the right side of the heart to pump blood through these blockages leads to pulmonary hypertension.

Group 5 Pulmonary Hypertension (PH) due to other disorders-

Group 5 PH is pulmonary hypertension caused by other conditions. The conditions may include-

Blood disorders: Polycythemia vera, essential thrombocythemia
Inflammatory disorders: Sarcoidosis
Metabolic disorders: Glycogen storage disease
Kidney disease

The actual mechanism through which these conditions cause PH is unknown.

How is pulmonary hypertension diagnosed and tested?

Pulmonary hypertension is difficult to diagnose early due to the reason that a routine physical examination hardly detects it. Even at more advanced stages, symptoms of pulmonary hypertension mimic symptoms of other heart and lung conditions.

For diagnosing pulmonary hypertension, your doctor will examine you and ask about your symptoms. You will most likely be asked about your medical history and family history.

These tests measure your pulmonary artery blood pressure:

Right heart catheterization: It is also referred to as pulmonary artery catheterization. It assesses your pressure inside your pulmonary arteries and the amount of blood pumped by your heart in a minute.
Doppler echocardiogram: A Doppler echo shows the function of your right ventricle by using sound waves. It also measures the blood flow through your heart valves. It makes it possible for your doctor to calculate your systolic pulmonary arterial pressure.

These tests are first done to identify the cause of the pulmonary hypertension:

Blood tests are usually used to check the levels of hormones, infections, and how organs function. Examples of blood tests include a complete blood count and a comprehensive metabolic panel.

Chest CT scanning is done to identify anomalies, clots, or anything else in the lungs that may be the cause or contributing factor to your pulmonary hypertension.
A chest X-ray may help determine if the right ventricle is enlarged or the pulmonary arteries are enlarged.
A pulmonary ventilation/perfusion (VQ) scan checks for blood clots in your lungs.

Your doctor may ask you to walk for six minutes. This will check your blood oxygen saturation during exercise and your capacity to exercise. You may view the results to understand your situation with pulmonary hypertension.

What is the treatment of pulmonary hypertension?

Treatment of pulmonary hypertension is aimed at relieving symptoms, improving quality of life, and slowing down the progression of the disease.

Treatment will vary depending on the severity of the illness and its etiology.

Medications:

Dilators: These drugs lower the blood pressure by dilating and relaxing the blood vessels of the lungs.
Diuretics, often referred to as "water pills," promote the removal of excessive fluid from the body.
Chemicals known as anticoagulants cause the blood to become thin or "watery," preventing clots from forming.
Oxygen therapy: At times, you will need supplemental oxygen.
Various drugs: Several drugs can be used to treat aspiratory hypertension and include the use of calcium channel blockers, endothelin receptor blockers, and phosphodiesterase-5 inhibitors.

Surgery or subsequent operations-

When medication fails to control symptoms of pulmonary hypertension, surgery can be prescribed. The following surgeries and procedures are applicable for the treatment of pulmonary hypertension:

Atrium Septostomy- A physician may prescribe this treatment if the pulmonary hypertension symptoms do not respond to medication. To perform an atrial septostomy, a doctor surgically opens a hole in the upper left and right chambers of the heart. This hole relieves pressure on the right side of the heart. Possible side effects include arrhythmias or abnormal heartbeats.
Lung or heart transplantation- In some cases, especially younger patients, lung or heart-lung transplants may be necessary. The patient will need lifelong drugs after the transplant to avoid rejection.

Stages of pulmonary hypertension-

Pulmonary hypertension occurs in four stages. The World Health Organization refers to these as "functional classes." They are based on symptoms you may experience and relate to your ability to function during your day-to-day activities. As PH deteriorates, symptoms tend to become more apparent and begin to affect daily activities.

Class 1: No symptoms exist.

Class 2: You feel normal at rest. But you are comfortable or even experience dyspnea while doing routine activities. These include house chores and climbing stairs.

Class 3: You feel normal even at night when you are sleeping. But you feel very tired and breathless, so you find it quite a task to do routine activities.

Class 4: You feel the symptoms even when you're sleeping. With any attempt at doing an activity, your symptoms worsen.

What are the ways of preventing pulmonary hypertension?

Pulmonary hypertension cannot be prevented all the time. You have a set of risk factors that you cannot control. If you have some of these risk factors, your physician may advise that you undergo preventive screenings for your heart and lung functions.

By taking all the necessary steps to prevent or control other medical disorders, one can certainly reduce the risk of pulmonary hypertension. Actions you can do include:

Create a workout schedule.
Ask your physician about the exercises that are safe for you.
Have a heart-healthy diet. Avoid processed foods, fast food, and other items heavy in saturated fat and salt.
Quit smoking and quit tobacco use.

Smoking and tobacco use are some of the biggest risk factors for both lung as well as heart disorders.

Quitting smoking is difficult, though, mainly when one has used tobacco for such a long time. Conversely, your doctor can help you find resources. Support groups can also be helpful.

Take blood pressure medications according to prescription, along with other medications prescribed.

Living With

What additional treatment will I need after developing pulmonary hypertension?

Typically, these will include:

Scheduled visits with your doctor include regularly checking your general well-being, blood pressure, heart rate, and symptoms.
Regular tests: To evaluate the functioning of the heart and lungs, some of which might be EKGs, pulmonary function tests, and echocardiograms.
Medication management: Your doctor will check the efficacy of your medication and adjust it as needed.
Lifestyle advice: You would be enlightened on nutrient intake, activity level, and all the other lifestyle factors that might determine your health.
Education and support: You will be forwarded to educational tools or support groups.

Why Tender Palm Super-Speciality Hospital for Pulmonary Hypertension?

Tender Palm Hospital has the most experienced team of Cardiologists, Cardiac Surgeons, and diagnostics with the latest and International standard infection control measures in Lucknow, India. The Cardiac Science Centre team has decades of experience in successfully treating Pulmonary Hypertension.