Pulmonary Hypertension

Pulmonary hypertension is a type of excessive blood pressure that affects the arteries in the lungs and on the right side of the heart. One type of pulmonary hypertension is pulmonary arterial hypertension (PAH), in which blood arteries in the lungs constrict, obstruct, or are damaged. The injury reduces blood flow in the lungs. Blood pressure in the lung arteries rises. The heart has to work harder to push blood through the lungs. The increased effort eventually leads the heart muscle to weaken and fail.

Symptoms

The symptoms of pulmonary hypertension emerge gradually. You might not see them for months or even years. Symptoms worsen as the condition advances. Symptoms of pulmonary hypertension include shortness of breath, blue or gray skin due to low oxygen levels, chest pressure or pain, dizziness or fainting episodes, quick pulse or pounding heartbeat, weariness, and swelling in the ankles, legs, and abdomen.

Causes

The typical heart has two upper and lower chambers. When blood goes through the heart, the lower right chamber pushes it into the lungs. The blood goes through the pulmonary artery, which is a main blood conduit. Blood typically flows freely from the lungs to the left side of the heart. These blood vessels comprise pulmonary arteries, capillaries, and veins. However, changes in the cells that line the lung arteries can cause the arterial walls to constrict, stiffen, expand, or thicken.

Pulmonary hypertension is classified into five types based on the cause.

• Group 1: Pulmonary arterial hypertension (PAH). Causes include unknown causes, changes in a gene passed down through families, the use of certain medications or illegal drugs, heart problems present at birth, and other medical conditions.
• Group 2: Pulmonary hypertension due to left-sided heart disease. The causes are left heart failure and left-sided heart valve disease.
• Group 3: Pulmonary hypertension due to lung disease. Scarring of the lungs, chronic obstructive pulmonary disease, sleep apnea, and long-term exposure to high altitudes in people at higher risk of pulmonary hypertension are all possible causes.
• Group 4: Pulmonary hypertension caused by chronic blood clots or pulmonary arterial blockages. Chronic blood clots in the lungs, as well as tumors that block the pulmonary artery, are possible causes.
• Group 5: Pulmonary hypertension caused by other medical conditions. Blood disorders, inflammatory disorders, metabolic disorders, and kidney disease are all potential causes.

Diagnosis

Pulmonary hypertension is hard to diagnose early because it's not often found during a routine physical exam. Even when pulmonary hypertension is more advanced, its symptoms are similar to those of other heart and lung conditions.

Tests

• Blood tests, chest X-rays, electrocardiograms (ECG or EKG), and echocardiograms can all be used to detect pulmonary hypertension. An echocardiography may be performed while exercising on a stationary bike or treadmill to determine how activity affects the heart. If you have this test, you may be asked to wear a mask that measures how well your heart and lungs use oxygen and CO2. If an echocardiography indicates pulmonary hypertension, this test may be used to confirm the diagnosis.
• During this treatment, a cardiologist inserts a thin, flexible tube called a catheter into a blood vessel, typically in the neck. The catheter is carefully inserted into the lower right heart chamber and pulmonary artery. A doctor can then take blood pressure readings in the main pulmonary arteries and right ventricle.
• Additional tests may be performed to assess the status of the lungs and pulmonary arteries. Exercise stress tests and computed tomography (CT) scans are two examinations that may provide additional information regarding the cause of pulmonary hypertension.
• A heart CT scan, also known as a cardiac CT scan, can reveal the heart's size as well as any pulmonary artery obstructions. It can aid in the diagnosis of lung illnesses that may contribute to pulmonary hypertension, such as COPD or pulmonary fibrosis.
• Screening for gene alterations associated with pulmonary hypertension may be recommended. If you have certain gene changes, other family members may also need to be checked.

Treatment

• Treatment for pulmonary hypertension is determined by the type of pH and any other medical issues you may have. Your healthcare team will personalize treatment to your specific needs. Currently, only two forms of pH can be treated directly: pulmonary artery hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Other types of PH are treated by addressing the underlying medical issues.
• Calcium channel blockers, diuretics, oxygen therapy, and pulmonary vasodilators are all options for treating pulmonary arterial hypertension (PAH).
• Anticoagulants, balloon atrial septostomy (BAS), balloon pulmonary angioplasty (BPA), medication, and pulmonary endarterectomy (PEA) are all options for treating CTEPH.
• The treatment for PH caused by heart or lung disorders focuses on addressing the underlying issues. Because there are so many distinct heart and lung disorders that induce pH, treatment approaches vary greatly from person to person.

Risk factors

Pulmonary hypertension is usually diagnosed in people ages 30 to 60. Growing older can increase the risk of developing Group 1 pulmonary hypertension, called pulmonary arterial hypertension (PAH). PAH from an unknown cause is more common in younger adults. Other things that can raise the risk of pulmonary hypertension are family history, being overweight, smoking, blood-clotting disorders, exposure to asbestos, congenital heart defects, living at a high altitude, and use of certain drugs, including cocaine or methamphetamine.

Prevention

It is not always possible to avoid pulmonary hypertension. Some risk factors are beyond your control. If you have risk factors, your doctor may suggest regular testing to monitor your heart and lung function. Taking steps to avoid or treat other medical issues can help reduce your chance of pulmonary hypertension. Create an exercise regimen, eat a heart-healthy diet, quit smoking and using tobacco, and take blood pressure and other prescription drugs as directed.

Conclusion

Pulmonary hypertension is a complicated and diverse illness that necessitates meticulous management and a proactive approach. While HIV presents substantial hurdles, continuous research and improvements in medical science offer hope for better treatments and results. If you or someone you know is having PH symptoms, seek medical attention right away. Early intervention can make a significant impact in maintaining heart and lung health, ultimately improving quality of life.