Occasionally, mild pulmonary hypertension is the primary disease. As a rule, the idiopathic form is associated with genetic heredity and is rarely recorded in modern medical practice.
Most often, the ailment is secondary – it develops against the background of other pathologies. There are many diseases that can lead to the development of pulmonary hypertension.
- Connective tissue diseases, including lupus erythematosus, rheumatoid arthritis, scleroderma.
- Some congenital heart defects.
- HIV infection.
- Severe forms of intoxication of the body, which is observed, for example, with prolonged use of cocaine, amphetamines.
- Blood diseases, including anemia.
- Chronic obstructive pulmonary diseases, especially in those cases when they are caused by inhalation of toxic gases, asbestos, coal particles.
- Syndrome of night apnea (respiratory arrest in a dream).
- Chronic thrombosis.
- Lesions of the left side of the heart (hypertension, coronary disease, acquired defects).
A life-threatening pathological condition – pulmonary arterial hypertension – only worsens over time. Blood pressure in the arteries connecting the heart and lungs rises, which poses a risk to human health. Proper treatment helps relieve symptoms so that the patient can feel better.
The disease is considered a type of high pressure, the increase of which can harm the right side of the heart muscle. This makes her work less efficient: blood circulation is deteriorating, and the cardiovascular system ceases to supply oxygen to the body.
Pulmonary hypertension is a syndrome of diseases that cause narrowing or blocking of the arterioles and capillaries in the respiratory organs. The heart receives a double load, which increases the pressure in the lungs.
Over time, the main muscle becomes weaker, which can lead to heart failure.
The norm of pressure in the pulmonary artery is:
- moderate – 12-14 mm Hg;
- systolic – 22-25 mm Hg
The disease is characterized by some abnormalities: the pressure in the pulmonary artery begins to increase for no apparent reason. Vascular resistance also rises. This can lead to heart disease and even death. Primary PH is divided into venous, thromboembolic and reticular species. In the classification according to ICD 10, she received the code 127.0.
Medical scientists still can not understand the exact cause of the disease. However, studies have revealed some diseases that can give impetus to the development of such a disorder as primary pulmonary hypertension. It:
- immunodeficiency virus (HIV);
- gene mutation;
- portal hypertension;
- chronic heart disease.
This is a complication that is observed in people with chronic insufficiency of the left ventricle of the heart, resulting from a violation of the regulation of vascular tone of smooth muscles.
Secondary pulmonary hypertension is a remodeling of the walls of blood vessels with the identification of abnormalities of elastic fibers and medial hypertrophy. It includes diastolic and systolic dysfunction.
This process leads to a thickening of the vascular walls and capillaries.
LH is a progressive disease that is difficult to stop. Treatment can only relieve pain and relieve some symptoms. It all depends on the severity of the disease. The following is a classification of pulmonary hypertension:
- Grade I: at the initial stage, the disease does not bring any discomfort. During exercise, the symptoms of LH remain invisible.
- Grade II: physical activity can cause fatigue, weakness, breathing problems, chest pain.
- Grade III: in a static position, the patient feels normal. However, physical activity provokes fatigue, dizziness, shortness of breath, arrhythmia, pain in the solar plexus.
- Grade IV: a person should not perform physical exercises, because breathing is difficult even in a calm state.
In most cases, pulmonary hypertension occurs due to a mutation in the gene. The disease can be asymptomatic and manifest after many years. Idiopathic disease occurs spontaneously. The main causes of pulmonary hypertension are presented below:
- drugs (cocaine or methamphetamine);
- liver disease (cirrhosis);
- lupus, rheumatoid arthritis, scleroderma, and other autoimmune diseases;
- Congenital heart defect;
- angina pectoris;
- lung diseases: emphysema, bronchial asthma, chronic bronchitis, pulmonary fibrosis;
- metabolic disorders;
- sleep apnea;
- taking drugs to suppress appetite;
- hormone therapy.
For a long time, a person may not notice his illness. However, with age, the following signs of pulmonary hypertension may appear:
- a hoarse voice;
- dry cough;
- discomfort in the abdomen;
- sternal pain;
- swelling of the legs and ankles;
- pain in the liver;
- hypertensive crisis.
LH is more common in adults from the age of 24. Young women aged 26 to 40 are most at risk. The disease is an aggravating factor during pregnancy, because it can be transmitted to a newborn baby. Diagnosis of pulmonary hypertension may take some time: the symptoms of the disease are too similar to other signs of damage to the heart and lungs.
You can see signs of pulmonary hypertension on an ultrasound of the heart, but additional examinations are needed to confirm the result. Be sure to consult with a pulmonologist and cardiologist. Specialists can prescribe the following tests:
- physical endurance test;
- blood test;
- CT of the lungs and heart;
- lung biopsy;
- chest x-ray.
Diagnosis of PH presents some difficulties for doctors. Often they begin to treat the patient too late. However, timely detection of the disease leads to a complete recovery, if we consider the primary type of disease. For patients with secondary PH, the prognosis may be disappointing. Treatment of pulmonary hypertension includes the use of the following medicines:
- muscle relaxants;
- vasodilator drugs;
- drugs that can thin the blood.
In the process of recovery, the patient will have to reduce physical activity and follow the prescribed diet to bring pulmonary pressure back to normal. It should reduce the intake of salt, drinking water. This will help reduce swelling of the limbs. If it was not possible to cure LH using the methods described above, transplantation of affected organs can be prescribed.
As a prophylaxis, it is worth giving up cigarettes, alcohol, more to be outdoors. You need to treat the disease comprehensively in a good clinic. Folk remedies for pulmonary hypertension can only alleviate the symptoms. Which plants help best:
- Bay leaf steamed with boiling water, great for inhalation. Fragrant fumes facilitate breathing and improve well-being. However, this tool should not be abused.
- Infusion of sage leaves, mint, valerian and St. John’s wort will help bring pressure to normal.
- Mountain ash decoction is applied similarly. It is best to use the berries and leaves of the plant.
- Pumpkin juice is a sure-fire way to strengthen your immune system and relieve symptoms of LH.
The information presented in the article is for guidance only. Materials of the article do not call for independent treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.
Patients who have been diagnosed with this disease are interested in the question of pulmonary grade I hypertension – what is it? Doctors at the Yusupov hospital use echocardiography or cardiac catheterization to determine the extent of the disease. Classification of pulmonary hypertension by pressure suggests 3 degrees of disease development:
- increase in pressure in the pulmonary artery by 25 – 45 mm RT. Art. indicates I degree of disease;
- increase in pressure by 45-65 mm RT. Art. – pulmonary hypertension of the II degree;
- increase in pressure by more than 65 mm Hg – pulmonary hypertension of the III degree.
Pulmonary hypertension syndrome is also classified depending on the observed clinical picture, with 4 classes being distinguished:
- Grade I: patients do not experience a decrease in physical activity. Habitual loads do not cause shortness of breath, dizziness, weakness and pain;
- Class II: patients experience a decrease in physical activity. Under normal loads, the patient experiences dizziness, shortness of breath, pain behind the sternum, weakness. At rest, these symptoms disappear;
- Class III: the physical activity of patients is significantly impaired. With a slight load, symptoms characteristic of the disease appear;
- IV class: a significant decrease in activity. Grade 4 pulmonary hypertension is characterized by severe symptoms both at rest and with minimal physical exertion.
Depending on the degree of development of the pulmonary heart and hypoxia, 3 degrees of pathology are distinguished.
Pulmonary hypertension of 1 degree. With the transient form, there are no clinical and radiological manifestations. At this stage, primary symptoms of respiratory failure may appear.
Pulmonary hypertension 2 degrees. With a stable stage of the disease, shortness of breath begins to develop and a pulmonary heart forms. When listening, you can hear the initial manifestations of increased pressure in the pulmonary artery.
At the third stage, an increase in the liver occurs, swelling appears, the skin changes color, the veins on the neck begin to swell strongly.
For a correct description, diagnosis of PH, a classification of the disease according to degree is accepted. The characteristic features in each case have their own characteristics. The symptoms of the disease, depending on the degree:
- The first is stable hypertension. Symptoms are subtle, physical activity persists, the usual load does not cause shortness of breath, dizziness.
- Second degree. Stable increase in blood pressure, signs of ventricular hypertrophy, respiratory failure. Chest pains, dizziness appear.
According to the classification, with the progression of the disease, the following degrees of increased pressure in the lungs are considered:
- The third is an irreversible stage. Atherosclerosis of the vessels, complete hypertrophy of the ventricle of the heart is formed. There is a prolonged cough, hemoptysis, swelling of the lymph nodes, lower extremities, severe shortness of breath with a small load.
- The fourth stage is constant weakness, pain. There is severe dyspnea in a state of rest, pathology of the digestive system, liver, causing a fatal outcome.
- Degrees of disease
- Pulmonary hypertension: causes, symptoms, treatment, complications
- Oxygen therapy
- North GL
- Features of the course of the disease
- When is surgery necessary?
- The use of folk remedies
- Pulmonary hypertension: prognosis
- Maintenance treatment
- Preventive measures
Degrees of disease
How does moderate pulmonary hypertension develop? The reasons lie in impaired functions or structures of the endothelium, which lines the pulmonary vessels:
- Endothelial dysfunction, which can be associated with both a genetic predisposition and exposure to external factors. The processes of metabolism of nitric oxide are disturbed, the tone of the vascular wall changes (spasm develops), resulting in an inflammatory process with further growth of the endothelium.
- Increased endothelin content. This substance has vasoconstrictor properties. The disease in this case can be associated with both increased production of this substance in the endothelium, and with a decrease in the rate of its decay in the lungs.
- In some cases, the growth of the endothelium is associated with additional excretion of potassium ions, as well as a violation of the synthesis of nitric oxide, a decrease in the level of prostacyclin.
As the disease develops, the patient’s condition worsens. The following symptoms appear:
- the appearance of a large amount of sputum during a cough, sometimes with streaks of blood; hemoptysis is possible, which indicates progressive pulmonary edema;
- angina attacks, accompanied by pain behind the sternum, the appearance of cold sweat;
- various cardiac arrhythmias;
- pain in the right hypochondrium, which is associated with venous congestion and an increase in the size of the liver;
- swelling of the legs, which are especially pronounced in the legs and feet;
- accumulation of fluid in the patient’s stomach.
If untreated, blood clots form in the arterioles of the lungs. Hypertensive crises, which most often begin at night, are characteristic. The patient complains of an acute shortage of air, to which a strong cough with bloody discharge joins. The skin takes on a bluish tint. The patient is afraid, moves erratically, loses self-control. In the most severe cases, the disease leads to thromboembolism of the pulmonary artery, which often ends in death.
- a disease with damage to the left side of the heart (for example, with heart defects, valve defects, prolonged heart failure, coronary artery disease);
- a disease with expansion of the pulmonary artery and increased flow through it (for example, the disease is a consequence and complication in people with congenital airways – congenital heart defects, often occurs with an atrial septal defect – ASD);
- a disease with respiratory disorders, pulmonary diseases, pulmonary capillary disorders (develops with COPD, pneumoconiosis, pulmonary thromboembolism – pulmonary embolism, systemic connective tissue disease).
Depending on the average pressure in the pulmonary artery, the classification of pulmonary hypertension distinguishes the disease by degree of: mild, moderate and severe.
Standards and phases are presented in the table.
Although systolic blood pressure values are not significant in determining the diagnosis of primary and secondary pulmonary hypertension, these values can be detected by echocardiography and can significantly help diagnose the disease.
From the point of view of etiology, 2 stages of pulmonary hypertension are distinguished:
- primary pulmonary hypertension;
- secondary pulmonary hypertension.
Primary pulmonary hypertension (idiopathic) develops for no known reason, mainly in younger women, with lesions of the small vessels (typical plexiform lesions), telangiectasia (vasodilation).
Hypertension of this nature has a poor prognosis (usually up to 3 years before right-sided heart failure).
Symptoms – shortness of breath with peripheral cyanosis, chest pain, fatigue dominates.
Secondary hypertension is directly or indirectly associated with another disease.
From the point of view of hemodynamics and pathophysiology (the pathogenesis of pulmonary hypertension plays a role in the classification) it differs:
- precapillary pulmonary hypertension;
- postcapillary hypertension;
- hyperkinetic form of hypertension.
The precapillary form of hypertension is characterized by normal pressure in the left ventricle. As a rule, the disease occurs:
- with pulmonary diseases (COPD, pulmonary fibrosis, sarcoidosis, pneumoconiosis);
- chronic thromboembolic disease (postembolic pulmonary hypertension);
- with primary damage to the artery;
- after lung resection;
- after hypoventilation.
The cause of postcapillary hypertension is left-sided heart disease (left-sided heart failure, mitral stenosis, hypertrophic cardiomyopathy), constrictive pericarditis.
The basis of hyperkinetic pulmonary hypertension is heart disease:
- atrial defects;
- defects of the ventricular septum;
- mitral valve prolapse;
- high cardiac output (e.g., hyperthyroidism).
In accordance with the timing of the development of hypertension, it is divided into 2 forms:
LH is classified and in accordance with ICD-10, has the international code I27.0.
Doctors distinguish several types of pulmonary hypertension:
- pulmonary arterial hypertension (PAH);
- LH in diseases of the valves, muscles of the left heart;
- LH in lung diseases;
- chronic thromboembolic pulmonary hypertension.
The main signs of pulmonary hypertension:
- shortness of breath (respiratory failure) – most often occurs and manifests itself mainly with tension, but also during or after eating, in more severe cases, shortness of breath manifests itself even at rest;
- chest pain – some patients indicate it as a slight tingling sensation, others as dull or sharp pain, which is often accompanied by palpitations (chest pain is present in ⅓ patients, but this symptom may be a sign of other cardiovascular diseases);
- dizziness – appears when lifting from a bed or chair, in some patients dizziness occurs only in a sitting position;
- fainting – if the brain does not receive enough oxygen for full activity, the person falls into a temporary unconscious state; fainting may occur with prolonged standing, when the blood stagnates in the veins;
- chronic fatigue;
- swelling of the ankles and legs – a very common symptom of hypertension, signaling heart failure;
- dry cough;
- bluish skin color, especially on the fingers and lips – this is a condition that signals a low oxygen content in the blood.
For the later stages, prolonged high blood pressure in pulmonary hypertension, the following symptoms are also characteristic:
- a person cannot perform the most mundane tasks that are performed in a normal state;
- the patient has symptoms of the disease even at rest;
- the patient tends to be in bed while aggravating the disease.
LH prognosis without treatment is poor. The median survival of the idiopathic form of the disease is 2,8 years. The median survival for a disease with systemic scleroderma is about 12 months. A similar prognosis has a disease associated with HIV infection. In contrast, a better prognosis than with the idiopathic form of LH is observed in patients with a disease associated with congenital heart disease.
LH prophylaxis is associated with timely diagnosis and treatment of diseases that can lead to the development of hypertension.
The first and most common manifestation of PLH is inspiratory dyspnea. At first, it is noted only with moderate physical exertion, later it begins to accompany everyday motor activity. In severe or prolonged course of the disease, respiratory rhythm disturbances occur suddenly at rest. Another common symptom is chest pain. By nature, it is aching, burning, compressing, pressing, stitching. Duration ranges from a minute to several days. As a rule, the pain grows gradually, noticeably worsens when playing sports, physical labor.
About half of the patients experience dizziness and fainting during exercise. Outwardly, this is manifested by a sharp blanching of the skin, and then the appearance of a bluish color of the face, hands and feet, clouding and sometimes loss of consciousness. The duration of such symptoms ranges from 1 to 20-25 minutes. In 60% of patients, palpitations and heart rhythm disturbances are detected, in 30% – an unproductive cough. Every tenth patient develops hemoptysis once or for several days. Over time, the shape of the fingers changes – the end phalanges are flask-like thickened, the nails are rounded.
Experts attribute pulmonary hypertension to one of the most common diseases of the cardiovascular system. Women aged 30 to 40 years are more susceptible to this disease than men. A patient experiencing the symptoms of this disease may not go to the doctor at the initial stages, since the general picture is quite erased.
If untreated, pulmonary hypertension leads to right ventricular failure, which can lead to the death of the patient. Signs of pulmonary hypertension detected by a person at this age should be a serious reason for contacting a specialized clinic.
Pulmonary hypertension does not have pronounced symptoms, so treatment begins in the later stages of the disease. However, specialists determined the symptoms of the initial stage of the disease:
- the appearance of small dyspnea at rest or with little physical activity;
- a hoarse voice or dry cough;
- weight loss for no apparent reason;
- heart palpitations, with the course of the disease on the patient’s neck, the jugular vein pulsation is clearly observed;
- depressed mood and a constant feeling of tiredness and weakness;
- fainting and dizziness, which are the result of hypoxia – lack of oxygen.
Pulmonary hypertension: causes, symptoms, treatment, complications
The etiology of the disease is not well understood. It is assumed that PLG belongs to hereditary pathologies. Patients are found to have mutations in genes that determine the production of vasodilator compounds – NO synthase, carbimyl phosphate synthase, serotonin transporters, and receptor activity of the type of the second bone morphogenetic protein. The mechanism of genetic transmission is autosomal dominant, accompanied by incomplete penetration. This means that the onset of the disease is possible in the presence of one or two defective genes in the allele, but sometimes the disease remains undeveloped. Mutation transmission occurs with a tendency to manifest pathology at an earlier age and with a more severe course in subsequent generations. Carriage of a mutational gene or genes leads to the development of symptoms not always, but only when exposed to triggering factors, which include:
- Drug, drug intoxication. PLH is potentiated by the use of amphetamines, L-tryptophan, aminorex, fenfluramine. A negative effect of meta-amphetamines, cocaine, chemotherapy drugs is suspected.
- Physiological conditions. Childbirth and gestation can provoke the onset of the disease. At high risk are pregnant women with diseases of the cardiovascular system, complications in childbirth.
- Accompanying illnesses. It has been established that systemic or portal hypertension, HIV infection, liver diseases, congenital shunts between pulmonary and systemic vessels predispose to the development of PLL. Probably thyro >
PLH is often complicated by thromboembolism of subsegmental branches of the pulmonary artery, atrial fibrillation, acute heart failure. The most characteristic right ventricular failure, which is manifested by edema, spreading from the lower extremities upwards, ascites, enlarged liver, swelling of the cervical veins, loss of body weight.
- heart rhythm disturbance – arrhythmia;
- signs of myocardial ischemia and angina attacks, in which the patient has a feeling of fear, cold sweat appears and pain behind the sternum appears;
- hemoptysis and the appearance of streaks of blood in the sputum.
At the terminal stage, tissue death occurs due to the formation of blood clots in arterioles. Hypertensive crises in patients manifest at night. Acute heart failure or a clot in a pulmonary artery can be a major cause of death.
The gradual narrowing of the arterioles and capillaries related to the pulmonary artery system precedes the development of the disease. In the late stages of artery damage, inflammatory destruction of the vessel wall can occur. As a result of these changes in the vessels, a progressive increase in pressure or pulmonary arterial hypertension occurs.
- an electrocardiogram is used to detect hypertrophy of the right ventricle and atrium;
- computed tomography provides information on enlarged arteries and the presence of concomitant diseases;
- echocardiography is performed to determine the speed of blood movement and examination of the cavities of the heart and blood vessels;
- X-ray of organs is used to establish the size of the heart and confirm the diagnosis;
- catheterization of the right heart and pulmonary artery is recognized as the most reliable method for diagnosing the disease. This method allows you to accurately determine the blood pressure;
- angiopulmonography is a method in which a contrast agent is introduced to establish a vascular pattern in the system of lung arteries.
Pulmonary hypertension in infants is extremely rare, the vast majority of these diagnoses are made in the first days of a baby’s life, which reduces the number of deaths.
- accommodation in the Far North, in the highlands;
- allergic reactions to food, smells of flowers, perfumes, chemistry;
- drug use;
- use of traditional medicine.
- Stenosis – what it is, causes, symptoms, localization, diagnosis, treatment and prevention
- Hydrocephalus in a child: treatment and consequences
- Hypertension syndrome – causes, signs, manifestations, types, diagnostic methods and therapy
Among the diseases that provoke an increase in blood pressure in the arteries of the paired respiratory organ:
- general hypoxia, diaphragmatic hernia in newborns;
- autoimmune damage to the membranes of the respiratory dolit tissue;
- violations of the structure of the spine, chest;
- acute heart failure;
- vasculitis in the area of the arteries of the lungs;
- heart disease;
- pulmonary fibrosis;
- mitral stenosis.
- fatigue, general weakness due to respiratory failure;
- heart pain as a result of vasospasm;
- obsessive cough due to the occurrence of congestion;
- dizziness, fainting as a result of circulatory disorders;
- secretion of mucus when coughing up blood due to rupture of capillaries;
- swelling of the legs caused by venous insufficiency.
Pathology can be observed in newborns, it is associated with the launch of pulmonary circulation during childbirth. The pressure surge in the vessels is dangerous for the baby’s life. If help is not provided in a timely manner, the illness can lead to death within a few hours. The baby has difficulty breathing, shortness of breath, signs of hypoxia. The causes of increased pressure in the lungs of the first degree in children are:
- complications after SARS, flu;
- transferred bronchitis, pneumonia;
- the use of aspirin, antibiotics.
- limitation of physical activity;
- prevention of anemia, infectious diseases;
- treatment with oxygen;
- the use of drugs that prevent the development of hypertension;
- surgical intervention at 3-4 degrees with complications;
- organ transplantation.
In the treatment of pulmonary hypertension of the first degree, drugs of several groups are widely used. Their action is aimed at eliminating the symptoms of the disease. Doctors prescribe:
- calcium channel blockers (vasolysers) that help vasodilatation;
- diuretics that lower blood pressure;
- anticoagulants that reduce blood coagulation;
- thrombolytics that prevent blood clots;
- heart rate normalizing agents;
- pressure stabilizing prostaglandins;
- blood thinners
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If the condition worsens, the patient is prescribed treatment using oxygen inhalations. Therapy makes you feel better with severe shortness of breath. Treatment for first-degree hypertension is used for natural and artificial ventilation by introducing oxygen. To do this, use:
- gas mixtures in cylinders or pillows;
- supply of pure oxygen centrally in a hospital;
- aerosol cans as an ambulance;
- hyperbaric oxygenation in the pressure chamber.
With the development of hypertension in the lungs, doctors recommend using physiotherapy to improve blood circulation, prevent blood clots. It is advisable to go through training with an instructor, and then do it yourself. Please note:
- the complex must be performed regularly;
- loads should not cause discomfort;
- with the third degree of the disease, activities are limited or discontinued.
Since chronic diseases become the causes of pulmonary pathology, their development must be prevented. A timely vaccination helps in this. The procedure helps to increase immunity to the disease, mitigate the harmful effects by introducing special antigenic material. Vaccination is carried out for the prevention of:
In the treatment of hypertension in the lungs, diet is a component of complex therapy. Patients are advised to reduce fluid intake, reduce the amount of salt. Alcohol, fatty foods, sweets, coffee, cholesterol-containing foods are contraindicated. Vitamin-rich foods are needed. In the diet you need to include:
- fresh fruits, vegetables;
- vegetarian soups;
- products containing magnesium, potassium;
- Rye bread;
- cottage cheese;
- in the highlands;
- in the Far North.
Low partial pressure of oxygen in the air is typical for mountainous areas. It leads to the development of PH of the first degree. Symptoms such as shortness of breath, cough, cyanosis appear. If a person is relocated to the foothills, treatment is started, a favorable prognosis of the disease is expected. With a long stay in the mountains:
- there is a weakening of cardiac activity;
- blood pressure drops, venous rises;
- arrhythmia, tachycardia develops;
- hypoxia occurs;
- hypertrophy of the right ventricle is formed.
The appearance of this variety is promoted by low air temperatures. Airway cooling occurs, bronchial resistance rises. All this causes pathology of the respiratory system, provokes hypertrophy of the ventricle of the heart. The disease is observed in most people living in the North for more than three years. Doctors note several stages of the disease associated with lung adaptation:
- the first – living up to a year – the pressure in the arteries of the lungs rises;
- the second – to two – the indicator is reduced;
- the third – over three years – is a strong increase, deterioration.
There is a narrowing of the blood vessels in the lungs, which makes it difficult for blood to pass through them. This function is provided by the heart. Due to a decrease in the volume of blood passing through the lungs, the right ventricle is disrupted, causing hypoxia and right ventricular failure.
The narrowing of blood vessels causes a violation of the function of their inner shell – the endothelium. Thrombus formation can be caused by an inflammatory process at the cellular level.
Concomitant cardiac or pulmonary diseases cause hypoxia. The body responds with a spasm of the pulmonary capillaries.
The primary pathology is characterized by a steady increase in pressure in the pulmonary artery, but the respiratory and cardiovascular systems are normal. There is also a thoracic-diaphragmatic syndrome (a form of respiratory failure).
Features of the course of the disease
When diagnosing hypertension, doctors use a variety of screening methods. Their goal:
- confirm or exclude the presence of the disease;
- determine the influence of factors contributing to the development of the disease;
- determination, assessment of the activity of the heart and lungs.
First, the attending physician compiles a medical history: asks about signs of lung disease, other diseases, medications taken, and illnesses of relatives. Then a detailed examination is carried out.
Diagnostic assistance is provided by the following research methods:
- electrocardiography (ECG) – assesses the heart load for hypertension;
- blood test – determines how well the blood is oxidized, helps to identify some factors that can contribute to the development of the disease;
- radiology, ultrasound – an x-ray determines the heart rate, pulse frequency, the state of the pulmonary arteries is visible on the x-ray;
- pulmonary scintigraphy – shows the supply of blood to the lungs;
- computed tomography (CT) – provides a refinement of the image obtained by cardiologists during x-ray examination, ultrasound diagnosis of the heart and lungs;
- echocardiography is one of the most important methods; ultrasound of the heart reveals the presence, assesses the severity of hypertension;
- spirometry – estimates the air flow in the lungs;
- cardiac catheterization – used to accurately measure blood pressure and blood flow in the lungs.
A patient with signs of increased pressure in the lungs comes to the clinic. The doctor begins with a survey, a medical history. To make a diagnosis, he:
- ascertains the time of onset of deterioration;
- analyzes heredity, bad habits, working conditions;
- conducts a visual examination – the presence of edema, the size of the liver, blue skin;
- listening to the lungs, heart.
Diagnostics includes a general and biochemical blood test. A walking test is performed to determine physical activity. In order to clarify the diagnosis, hardware studies are performed:
- Ultrasound of the heart;
- chest x-ray;
- ECHOCG – measurement of arterial pressure;
- pulmonary tomography;
One of the hardware methods for diagnosing hypertension syndrome is an ultrasound examination of the heart, in which the thickness of its walls is determined. In the case of pathology, hypertrophy of the right ventricle is observed. When diagnosing with ultrasound, the following indicators are taken into account:
- thickness greater than 10 mm – a sign of increased pressure in the lungs;
- ventricular wall less than 4 mm – normal.
Hypertension is diagnosed by catheterization or echocardiography. The study of echocardiography determines several parameters of the pathology. One of the indicators is the pressure in the bloodstream of the pulmonary artery. The increase in its values depends on the degree of pulmonary hypertension and is in mm RT. Art. when:
- the first – by a value of 25-45;
- second degree – 45-65;
- the third – more than 65.
The diagnosis of primary pulmonary hypertension is difficult because the symptoms are nonspecific and the incidence of the disease is negligible. The examination is carried out by a cardiologist, therapist. Patients complain of weakness, shortness of breath, chest pain. When collecting an anamnesis, the presence of a provoking factor (viral infection, pregnancy, childbirth) and family burden is often determined. In order to clarify the diagnosis, exclude heart defects, recurrent pulmonary embolism, COPD and myocardial diseases, it is carried out:
- Physical research. During the inspection, acrocyanosis (cyanosis of the skin) is detected. Right ventricular heart failure is manifested by swelling of the veins of the neck, swelling of the limbs, and the accumulation of fluid in the peritoneal organs. Auscultation of the heart reveals the accent of the second tone over the pulmonary artery, pansystolic murmur, Still’s murmur.
- Lab tests. A clinical and biochemical blood test, a test for thyroid hormones, anticardiolipin antibodies, D-dimer, antithrombin III and protein C are prescribed. The results allow us to differentiate cardiovascular diseases, for example, to exclude thrombophilia. With PLG, it is possible to determine a low titer of anticardiolipin antibodies.
- Instrumental diagnostics. According to the ECG results, EOS deviates to the right, the right heart ventricle and atrium are hypertrophied, dilated. With phonocardiography, hypertension, hypervolemia of the pulmonary circulation are diagnosed. When X-ray analysis of OGCs, the left branch and trunk of the pulmonary artery swell, the roots of the lungs are expanded, the right structures of the heart are enlarged. By cardiac catheterization, blood pressure inside the lung artery is measured, minute volume of blood, total pulmonary vascular resistance are estimated. The diagnosis of PLH is confirmed with DLASr. from 25 mm. Hg. Art. at rest or below 30 mm Hg. Art. with load, DZLA not higher than 15 mm. Hg. Art., OLSS not less than 3 mm RT. Art./l / minute.
A moderate degree of pulmonary hypertension can sometimes be asymptomatic, which greatly complicates the diagnostic process. If you suspect the presence of this pathology, you must conduct the following tests:
- blood pressure measurement;
- electrocardiogram (during the study, you can notice thickening and expansion of the ventricles, the appearance of extraordinary contractions of the heart, as well as atrial fibrillation);
- X-ray examination (in the pictures you can see that the borders of the heart are shifted to the right, the shadow from the arc of the pulmonary artery has become clearer, and the peripheral transparency of the lungs is increased);
- echocardiography (allows you to determine the presence of heart defects, measure pressure, etc.);
- magnetic resonance imaging and computed tomography.
The signs of pulmonary hypertension are often not very specific, so it is difficult to correctly establish the root cause of the disease based on complaints and external examination alone. Only with the help of a thorough diagnosis can you see all the pathologies and failures in the body. Consultation must be done by a pulmonologist and cardiologist.
How is the diagnosis:
- Anamnesis – the definition from the patient’s words the time of deterioration, how the disease manifests itself, with which the appearance of unpleasant symptoms may be associated.
- Lifestyle analysis – the presence of bad habits, hereditary diseases, working conditions.
- Visual inspection – blue skin, a change in the shape of the fingers and the condition of the nails. The doctor notes whether there is swelling, a change in the size of the liver. Be sure to carefully listen to the phonendoscope of the lungs and heart.
- ECG – with its help, changes in the size of the right heart are determined.
- An x-ray of the chest area allows you to see an increase in heart size.
- Catheterization (pressure measurement) of an artery.
The most informative type of diagnosis is echocardiography. Signs of pulmonary hypertension on ultrasound of the heart appear as hypertrophy of the right ventricle. Indicators less than 4 mm indicate the absence of pathology. If the wall thickness of the ventricle exceeds 10 mm – this indicates the development of pulmonary hypertension.
When is surgery necessary?
The propaedeutics of LH is currently not extensive enough, the identification of the causes of the disease continues. Based on the determination of the type of hypertension (for reasons), the group and dosage of the drugs used are based. The action of the drugs is aimed at the following results:
- expansion of blood vessels;
- decrease in blood coagulability;
- a decrease in the amount of flu >
The most effective therapeutic method is long-term inhalation of oxygen (14-15 hours / day).
The treatment of primary hypertension is very complex. Some compounds are used, leading to the expansion of the pulmonary vessels, therefore, reducing the pressure in the pulmonary vascular bed. One of these compounds, Sildenafil, is a first-line drug for pulmonary hypertension.
Heart failure, usually present in PH, is symptomatically treated. The final solution in certain situations is lung transplantation.
In the secondary form of the disease, treatment of the underlying disease is necessary. If therapy is successful, hypertension is relieved.
High doses of calcium channel blockers (Nifedipine, Diltiazem, Amlodipine) and nitrates are recommended only if vasoreactivity is maintained.
Residual pulmonary hypertension (resulting from heart defects) involves the use of ACE inhibitors in combination with other drugs.
If classical therapy is ineffective, a decision is made on the surgical treatment of pulmonary hypertension. It includes the application of the following methods:
- pulmonary endarterectomy;
- atrial septostomy;
- lung transplantation.
The purpose of the procedure is the removal of organized blood clots from the pulmonary artery with part of its wall.
This unique and complex operation is the only treatment option for chronic hypertension due to relapse of pulmonary embolism, which can lead to a complete cure of the patient. Before introducing this method into practice, most patients with this form of the disease died within a few years.
The key part of the operation is performed in deep hypothermia of the patient with complete circulatory arrest.
Atrial septostomy is aimed at improving the performance of right-sided heart failure in patients with hypertension. This fact follows from an article published by a group of Polish scientists in the April issue of the professional journal “Chest”. Atrial septostomy is used as a temporary treatment while waiting for transplantation or in patients in whom transplantation is not taken into account, but all therapeutic methods have not shown efficacy in the disease.
Lung transplantation is a complex operation, during which one (both) lungs or the lung-heart complex are displaced from the donor to the recipient. This is the last therapeutic option for the terminal stages of the disease.
Types of lung transplantation:
- unilateral transplantation, as a rule, is carried out with LH accompanied by COPD, fibrotic diseases, emphysema, obliterating bronchiolitis;
- bilateral transplantation – recommended in the presence of cystic fibrosis, bronchiectasis, histiocytosis;
- lung-heart complex transplantation – performed in the presence of cardiovascular diseases, primary parenchymal disease associated with damage to the myocardium or inoperable valve disease.
Moderate pulmonary hypertension is often amenable to medical treatment. However, for rapidly progressing symptoms, surgical intervention is sometimes necessary.
Sometimes the doctor performs balloon atrial septostomy. A catheter with a blade and balloon is inserted into the patient’s left atrium. Thus, the doctor makes a small incision between the atria, and then with the help of the balloon expands the hole. This procedure allows you to create a current of oxygenated blood from left to right.
Unfortunately, sometimes a patient needs a lung and heart transplant. Unfortunately, such a procedure can only be carried out in specialized medical centers, which are not so many in the countries of the former CIS. Another problem is the shortage of donor organs.
After a thorough diagnosis, medication should be started immediately. The goal of therapy is to eliminate or adjust the main manifestations of the disease, to prevent the development of concomitant diseases.
Drugs for choice for pulmonary hypertension:
- Calcium channel blockers – Prazosin, Nifedipine. These drugs are prescribed at an early stage of the disease. Verapamil is not recommended for use in the treatment of hypertension, since the therapeutic effect of the drug is rather weak.
- Drugs that thin the blood – Aspirin, Cardiomagnyl.
- Diuretic medicines – Lasix, Furosemide.
- Digoxin is a cardiac glycoside. The drug is indicated for atrial fibrillation to normalize heart rate.
- Anticoagulants – Warfarin, Heparin. Medications are used to prevent blood clots.
- Prostaglandins and their analogues – Treprostinil, Epoprostenol. Medications to normalize pulmonary pressure.
- Bozentan – slows down the development of pulmonary hypertension.
- Medicines that improve the processes of metabolism in cells – Riboxin, Potassium Orotat.
For several years, scientists have been conducting a study on the effectiveness of using sildenafil in the treatment of pulmonary hypertension. Sildenafil citrate is the main component of Viagra and is designed to eliminate erectile dysfunction.
The drug was used on patients for 12 weeks. In the control groups that received 20–80 mg of the drug, the performance improved significantly.
If the patient’s hemoglobin level exceeds 170 g / l, the cervical veins are bulged out – bloodletting is performed. Positive results give oxygen inhalation, which must be done in courses.
It is possible to reduce the progression of the disease with the help of surgical intervention. Using the method of shunting – create an artificial oval window between the atria, which is why high pulmonary hypertension is reduced. This allows you to extend the life of the patient, forecasts of the course of the disease are significantly improved.
Organ transplantation is also used – to eliminate pathology, it is enough to transplant 1 lung. But after 5 years, many patients begin rejection.
Important! In the later stages of the disease, a heart and lung transplant is possible. To carry out a similar operation at the beginning of the development of pathology is impractical.
Even traditional medicine is not able to completely eliminate pulmonary hypertension. Therapy will be effective only if it is possible to eliminate the cause of the disease. Treatment with folk remedies is aimed at reducing the symptoms.
- Brew 225 ml of boiling water 5 g of ripe mountain ash, leave for an hour. Take 110 ml three times a day. The duration of therapy is 1 month.
- You can get rid of arrhythmias with fresh pumpkin juice. You need to drink 100 ml of drink per day.
- Also, for treatment and prevention, you need to eat 4 juniper berries daily. You can also make an infusion from them. Pour 25 g of fruit into a thermos, add 260 ml of boiling water, leave overnight. The medicine is divided into 4 servings, drink in 1 day.
- Adonis helps to eliminate the main manifestations of the disease, relieves pulmonary edema. Brew 220 ml of boiling water 3 g of raw materials, leave for 2 hours. Take 30 ml before meals.
Peel and grind 2 fresh heads of garlic, put the mixture in a glass container, pour 230 ml of vodka. Insist 15 days in a dark, cool room. Take tincture 5 times a day. A single dose is 20 drops – the medicine must be diluted in 15 ml of warm water or milk. The duration of therapy is 21 days.
For alcohol intolerance, a medicine is made of 3 large heads of garlic and 3 crushed lemons. Pour the mixture with 1 liter of boiling water, close the container, leave for a day. Take 3 times a day for 15 ml.
Alcohol tincture is prepared from calendula inflorescences. Pour 160 ml of vodka 60 g of raw materials, leave for a week. Take 25 drops three times a day for 3 months.
Here are some more recipes:
- Grind 22 g of dried birch leaves, pour 420 ml of boiling water, put in a dark, cool room for 2 hours. Take 105 ml four times a day. The duration of treatment is 15 days.
- Brew 245 ml of boiling water 6 g of flax grass, leave for an hour in a closed container. Take 35 ml 36 times a day.
- Powder the corn stigmas. To 50 g of powder add 100 ml of fresh honey, take a medicine of 5 g before meals 3-5 times a day.
Important! Alternative methods of treatment must be used only in combination with drugs.
If conservative methods have not yielded results, the patient is prescribed surgical treatment. The choice of the type of intervention depends on the condition of the patient, the features of the development of PH, its degree. Apply surgical methods:
- pulmonary thromborectomy;
- correction of congenital heart disease;
- balloon atrial septostomy;
- transplantation of the lung, heart.
The essence of this surgical method of treatment is the removal of blood clots from the branches of the pulmonary artery. The operation is performed until the blood clot has degenerated into connective tissue. Throendarectomy helps reduce the load on the right ventricle of the heart, weaken the manifestations of heart failure. During surgery:
- using angiography to determine the site;
- a catheter is inserted;
- cut the affected vessel along the edge of the thrombus;
- under the control of an x-ray, a balloon catheter is inserted;
- fill it with saline;
- pulled back together with a thrombus;
- repeat until the artery is completely cleansed.
The purpose of this surgery is practiced with idiopathic pulmonary hypertension, in the last stages of the disease or in the absence of treatment results for right ventricular heart failure. In the atrial septum, a special hole is made with a special catheter with a balloon. The operation helps:
- reduce the burden on the heart;
- facilitate his work;
- increase cardiac output;
- reduce the frequency of fainting;
- eliminate dizziness;
- improve exercise tolerance;
- prepare for transplant surgery.
The use of folk remedies
What can be done at home if a patient is diagnosed with moderate pulmonary hypertension? Of course, traditional medicine offers a lot of recipes:
- Useful is fresh pumpkin juice, which contains a huge amount of potassium (this mineral is useful in some types of arrhythmias). Patients are advised to take half a cup per day.
- You can make an infusion of spring adonis. A teaspoon of grass should be poured with a glass of boiling water, and then insisted for two hours. The filtered liquid is taken 2 or 3 times a day for two tablespoons. The medicinal plant has analgesic and diuretic properties.
- Useful properties have the fruits of red mountain ash. A decoction of them (a tablespoon of raw materials per 200 ml of boiling water) helps to remove swelling, saturates the body with vitamins, and also reduces the sensitivity of cells to oxygen levels in the blood.
Simultaneously with medications, you can alleviate the symptoms of the disease with folk remedies. Sometimes they have a similar effect on health, like modern medicines. Folk remedies include:
- ginseng extract;
- barberry extract;
- ginkgo biloba leaf extract.
When used as monotherapy, it is hardly possible to cure a serious illness, but natural remedies have proved their effectiveness over the centuries provided that they are used in balanced proportions. Therefore, it is advisable to use them as supporting therapeutic methods for the disease.
Pulmonary hypertension: prognosis
Without proper treatment, life expectancy for pulmonary hypertension is 2,5 years. The disease passes from the primary stage to the secondary, the symptoms of the disease are aggravated, the condition worsens noticeably.
Against the background of insufficient oxygen supply to tissues, a strong and frequent shortness of breath develops, which occurs even in a calm state. Hypoxia leads to an increase in blood viscosity – blood clots occur that can clog vessels in the lungs.
Indicators of mean pressure in the pulmonary artery are an important factor in life expectancy. If the indicators stably stay above 30 mm RT. Art. and do not decrease under the influence of medications – life expectancy will be about 5 years.
Important! Positive forecasts can be made if therapy with calcium channel blockers leads to an improvement in the patient’s condition, the signs of the disease gradually recede. In this case, only 5% of patients live less than 5 years.
Pulmonary hypertension often leads to disability. With this disease, many types and conditions of work are contraindicated – heavy physical labor, mental work with high nervous overloads and strong speech load. People with this diagnosis are not allowed to work in rooms with high humidity, severe changes in temperature and pressure.
With pulmonary hypoxia, you can’t work in hazardous production – dust, irritating gases, poisons and other allergens can worsen the condition of the patient.
The average life expectancy of patients is 3-5 years. The search for effective treatments continues. Currently, doctors are able to reduce the risk of death through lung transplant surgery, but mortality rates remain high. A system of preventive measures has not been established, geneticists and cardiologists are developing methods of screening tests that will identify families with a history of history and people at risk.
High lung pressure is a serious problem. The first degree of LH is difficult to treat – life expectancy is not more than two years. The prognosis of recovery depends on many factors:
- in the case of PH on the background of systemic scleroderma – life no more than a year;
- with the progression of insufficiency of the functions of the right ventricle – die in two;
- the prognosis is favorable as a result of the response to the treatment – about 70% live more than five years;
- in the secondary form complicated by heart failure, 45% of patients have five-year survival.
What should patients expect to be diagnosed with moderate pulmonary hypertension? The forecast directly depends on the general condition of the person. As a rule, a mild form of the disease responds well to therapy. If the patient’s condition improves during treatment, the pressure in the vessels gradually normalizes, then we can talk about a favorable prognosis.
On the other hand, some people go to the doctor with more advanced stages of the development of the disease. Serious blood flow disorders, congestion, pulmonary edema, ascites – all this significantly reduces the likelihood of a full recovery.
The prognosis and treatment of pulmonary hypertension depends on the form and stage of the disease. According to statistics, with modern treatment methods, the mortality rate of patients with a chronic form is 10%. Five-year survival of patients with primary pulmonary hypertension varies from 20 to 35%.
The following factors influence the overall forecast:
- the degree of pulmonary hypertension in pressure: with a decrease in pressure in the pulmonary artery, the prognosis will be favorable, with an increase in pressure of more than 50 mm Hg – unfavorable. A patient diagnosed with secondary pulmonary hypertension is more likely to receive a favorable prognosis;
- an increase in the symptoms of the disease or a decrease in their severity;
- improvement or worsening of the patient’s condition with therapeutic treatment;
When pulmonary hypertension develops in newborns, the prognosis depends on how long the doctor identifies the problem. In most cases, it takes up to 3 days to make a diagnosis, after which doctors begin to carry out a range of therapeutic measures.
Diuretics relieve symptoms of congestion in heart failure. Long-term home oxygen therapy should last at least 15 hours a day (indications for patients with Eisenmenger syndrome are contradictory, usually a procedure for this disease is not recommended).
Chronic anticoagulant therapy (Warfarin) is indicated primarily for patients with an idiopathic hereditary disease to reduce the risk of catheter thrombosis. The INR (international normalization ratio) should be around 2.
After eliminating the main acute symptoms of a pulmonary disease, it is recommended that a healthy lifestyle (appropriate diet, good rest), the prevention of exposure to risk factors, and sanatorium recovery (for example, treatment in salt mines) are recommended.
Prevention of pulmonary hypertension syndrome should be carried out comprehensively and include:
- quitting smoking and other bad habits;
- timely identification of the problem and development of a treatment plan;
- regular monitoring of patients with confirmed bronchopulmonary diagnoses;
- elimination of stressful situations;
- control of physical activity and stress.
At the Yusupov hospital, patients with pulmonary hypertension are diagnosed and treated. Timely diagnosis will improve the quality and life expectancy.
Call the Yusupov hospital and make an appointment. The coordinating physician of the center will answer all your questions.
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