respiratory health

Pulmonary Hypertension - Symptoms, Diagnosis, Therapy

Symptoms and complications

To learn more: Pulmonary Hypertension Symptoms

In the early stages, pulmonary hypertension is often asymptomatic (that is, devoid of obvious signs and symptoms).

Figure: dyspnea (shortness of breath) is one of the typical symptoms of pulmonary hypertension

However, with the worsening of vasoconstriction on the pulmonary arteries, the first pathological manifestations begin to appear.

The main symptoms of pulmonary hypertension are:

  • Dyspnea (or shortness of breath), both under stress ( dyspnea on exertion ) and at rest ( dyspnea at rest )
  • Dizziness
  • Sense of fainting and syncope
  • Pain or sense of pressure in the chest
  • Edema in the legs, hips and sometimes even the abdomen ( ascites )
  • Cyanosis
  • Increased heart rate ( tachycardia or palpitation )
  • Sense of fatigue

WHEN TO REFER TO THE DOCTOR?

The appearance of an unusual dyspnea during even minimal effort should induce the victim to contact their doctor immediately, for a deepening of the situation. In addition, symptoms and signs such as chest pain, edema in various parts of the body and cyanosis should also be considered worthy of further study.

COMPLICATIONS

In the long run, the condition of pulmonary hypertension can lead to the following complications:

  • Pulmonary heart . It is a very serious cardiac pathology, characterized, first, by an enlargement of the right ventricular cavity and, subsequently, by a thickening of the muscular wall that constitutes the right ventricle (right ventricular hypertrophy).

    These alterations are the adaptive response to the narrowing of the pulmonary arteries and to the difficulties that the blood encounters when crossing them.

  • Tendency to clots inside the blood vessels that carry blood into the lungs . The thromboses that cause the most serious effects are those that affect the smallest branches of the pulmonary arteries, as they very easily obstruct these vessels.
  • Arrhythmias . As the condition of pulmonary hypertension worsens, tachycardia can be complicated by arrhythmias (ie abnormal heart rhythms), even deadly.
  • Bleeding in the lungs . The characteristic sign is hemoptysis, ie the blood emitted with the cough.
  • Heart failure (or heart failure) . It is the pathological condition whereby the heart cannot effectively pump blood to all the districts of the body. The classic symptoms include severe dyspnea even at rest and a sense of persistent fatigue.

Diagnosis

Pulmonary hypertension is difficult to diagnose because, even when it is symptomatic, it is very similar in symptoms and signs to other heart and lung diseases.

Therefore, in order to be able to highlight their presence, the doctor is required to submit the patient to various tests and diagnostic tests.

Usually, after a thorough physical examination, they follow:

  • Blood tests
  • Chest X-ray
  • Echocardiogram
  • Right heart catheterization
  • Spirometry
  • Pulmonary perfusion analysis
  • TAC
  • Nuclear magnetic resonance
  • Pulmonary biopsy

The considerable number of diagnostic tests is due to the fact that the doctor, in addition to wanting to diagnose pulmonary hypertension, also needs to establish the precise causes of the latter. In fact, once the reasons for the disease have been identified, it is easier to plan an adequate treatment.

EXAMINATION OBJECTIVE

First of all, during the physical examination the doctor visits the patient and asks him to describe the symptoms felt. Then, he goes on to the analysis of clinical history (current health status, past illnesses, etc.) and lifestyle habits (he wants to know, for example, if the patient is a smoker, if he drinks alcohol, etc.).

BLOOD TESTS

Obtained by simple sampling, the patient's blood sample may have values ​​related to pulmonary hypertension because they are dependent on other associated morbid conditions (this is the case, for example, with systemic lupus erythematosus ).

However, it must be remembered that blood tests are a little specific diagnostic method that requires further confirmation.

CHEST X-RAY

The chest X-ray provides a fairly clear image of the heart, pulmonary arteries, lungs and any abnormalities.

However, it has been noted that a large proportion of patients with pulmonary hypertension (about 1/3) is completely normal in this test.

ECHOCARDIOGRAM

The Doppler echocardiogram is an ultrasound examination that shows in detail the appearance of the heart, the possible anomalies of the latter and the dynamics of the blood flow through atria, ventricles and heart valves. It allows, in fact, to identify valvular defects, difficulty pumping the heart and malformations of the myocardium (including dilations of the cardiac cavities and thickening of the walls).

The echocardiogram is a simple and non-invasive examination, which involves the use of an ultrasound probe ( transducer ) resting on the patient's chest.

Doppler echocardiogram variant

Sometimes, to get more specific information about the heart, doctors use transesophageal echocardiography . Its greater specificity has a price: the examination, in fact, is invasive, as it involves the insertion of the transducer into the patient's esophagus.

RIGHT CARDIAC CATHETERISM

Right heart catheterization is a delicate and somewhat invasive procedure, which requires the use of a particular catheter. This catheter, once inserted in an important vein of the body and carried to the right ventricle and to the pulmonary arteries, allows to measure the blood pressure inside the latter.

In the case of pulmonary hypertension, the mean pulmonary arterial pressure in resting conditions is greater than 25 mmHg.

Cardiac catheterization is performed in a specialized hospital ward and includes local anesthesia.

SPIROMETRY

Fast, practical and painless, spirometry records the inspiratory and expiratory capacity of the lungs and the patency (ie, opening) of the airways passing through them.

It is necessary to establish lung function.

ANALYSIS OF PULMONARY PERFUSION

The exam studies the way the blood diffuses into the blood vessels that reach the lungs.

During the analysis, the doctor injects a radioactive substance into a patient's vein, visible with a special instrument. In subjects with pulmonary hypertension, it highlights where the pulmonary arteries or their ramifications shrink.

The main drawback of pulmonary perfusion analysis is the use of radioactive materials.

Attention: combined with the study of the patient's ventilatory capacity, the analysis of pulmonary perfusion is called pulmonary scintigraphy (or V / Q scan or fan-perfusory scintigraphy ).

TAC AND NUCLEAR MAGNETIC RESONANCE

CT ( computerized axial tomography ) and nuclear magnetic resonance ( RMN ) are two diagnostic imaging tests which, in the case of pulmonary hypertension, allow us to highlight changes in the pulmonary arteries or their ramifications.

The CT scan, unlike MRI, is an invasive exam, as it exposes the patient to a minimal dose of ionizing radiation.

PULMONARY BIOPSY

Lung biopsy consists of taking and analyzing in the laboratory a small sample of lung tissue from the patient. The collection can be done by bronchoscopy, bronchoalveolar lavage or surgery.

Treatment

Establishing the correct therapy to adopt in the case of pulmonary hypertension can sometimes be quite complicated. In fact, the treatment varies from patient to patient, depending on the causes and other pathological conditions that accompany pulmonary hypertension (causal therapy).

Generally, a combination of different drugs is provided; the choice of the most appropriate association for the case occurs after some tests: the medicines that, after such tests, are more effective are definitively prescribed.

However, it is important to remember that even the most adequate pharmacological therapy does not completely cure pulmonary hypertension, but is limited only to improving its associated symptoms.

Should any drug treatment prove to be ineffective, surgery should be considered.

PHARMACOLOGICAL TREATMENT

To know in detail what are the possible drugs that can be used in case of pulmonary hypertension, the reader is referred to the following article.

SURGERY

The surgical operations that can be used in case of pulmonary hypertension are:

  • Atrial septostomy . It is an "open heart" surgery, during which the attending physician practices a small hole in the structure that separates the right atrium from the left atrium (interatrial septum). This should reduce the blood pressure inside the right heart and inside the vessels that depart from it.

    Possible complications: after its execution, the patient could suffer from arrhythmias.

  • Heart, lung or both transplantation . They are very delicate surgical procedures, during which the malfunctioning organs are replaced with other healthy ones, coming from compatible dead donors.

    Possible complications: the patient who has undergone an organ transplant could reject the same organ following an abnormal immune reaction (transplant rejection). Moreover, the high intake of immunosuppressants (which serve precisely to avoid rejection) predisposes to infections.

SOME ADVICES

If you suffer from pulmonary hypertension, it is good practice to follow certain rules, including:

  • Stay at rest when the need is felt.
  • Practice physical activity regularly . Obviously, such physical activity must be commensurate with the state of health, as exaggerated efforts could be fatal.
  • No smoking .
  • If you are a woman, avoid becoming pregnant, because pregnancy could make the situation worse. Furthermore, the life of the fetus is also in danger.
  • Avoid going to or going to live at high altitudes .
  • Avoid all situations that could strongly reduce blood pressure ( hypotension ), such as too hot baths or saunas. An excessive drop in blood pressure can lead to fainting and even death.
  • Adopt a healthy diet and possibly low in salt (low salt diet ).

Prognosis

Pulmonary hypertension significantly affects the quality of life of those affected. Its establishment, in fact, prevents us from carrying out many activities that characterize a normal existence.

The prognosis depends heavily on when the diagnosis takes place and when the treatment begins: in fact, the sooner the pulmonary hypertension is highlighted and treated, the greater the survival rate at 5 years after diagnosis.