Pulmonary hypertension: Causes, symptoms, risk factors, complications, diagnosis, treatment

Pulmonary hypertension is a type of high blood pressure that takes a toll on the arteries present in the lungs and also the right side of the heart and this condition is more commonly seen in women. The lung is an important organ of the body which takes part in the gas exchange of oxygen and carbon dioxide and along with the heart, it forms a unit called the cardiopulmonary system.

In an interview with HT Lifestyle, Dr Chandrashekhar Kulkarni, CVTS Surgeon and Heart and Lung Transplant Surgeon at Global Hospital in Mumbai, explained, “The heart pumps blood to the lungs at some pressure (normal of about max 25 mm Hg ) to maintain the circulation of blood in the lung. In a few of the patients, this pulmonary pressure is raised leading to a condition called pulmonary hypertension ( PH). Primary pulmonary HTN (PPH) is a rare disorder where the unregulated blood pressure in the lungs hampers blood circulation and causes irreversible changes in the lung capillaries and ultimately leads to a reduction of gas transfer across the membrane.”

Cause:

According to Dr Chandrashekhar Kulkarni, this condition can occur due to primary (unknown) causes or secondary to obstruction of blood flow.

Symptoms:

Dr Chandrashekhar Kulkarni revealed, “Most of the patients are usually asymptomatic in the early stages and as the pulmonary pressure rises beyond 50 mm they start to manifest common symptoms like early fatigue, breathlessness, tiredness, difficulty in climbing stairs, or more commonly seen as reducing exercise tolerance. The signs of early PPH ARE subtle and difficult to pinpoint unless there is a high incidence of suspicion or further tests are done. Later or end-stage symptoms include swelling of feet, abdominal fluid collection, chest fluid collection, low BP and inability to lie flat during sleeping.”

Risk factors:

  • Having a family history of PH
  • Being overweight
  • Certain medication
  • Having congenital heart disease can lead to this condition.

Talking about why this condition is prevalent in females when compared to males, Dr Chandrashekhar Kulkarni said, “PH is more common in females and can occur as early as 15 to 20 years of age and even during pregnancy. Pregnancy usually induces a bit of hypertension which levels off often in delivery. But in very few patients it may not. Even autoimmune disorders like lupus and rheumatoid arthritis, are common in women and can invite this condition.”

Complications:

Highlighting the complications that occur due to this condition, Dr Chandrashekhar Kulkarni said, “The main problem of PH is that the right ventricle of the heart is usually the one that starts suffering from failure and can lead to an abnormally dilated right heart. Uncorrected PH can cause such advanced RIGHT ventricle failure that the patient can turn blue or can have a cardiac arrest. Such dilated RV is usually not amenable to medical treatment and only a heart and lung transplant can be an option for such people.”

Diagnosis:

“Few patients get diagnosed during pregnancy and managing both the mother and pregnancy can be a difficult situation but thorough clinical examination, ECG, x-ray chest and 2D echo are simple tests to monitor and diagnose the condition,” revealed Dr Chandrashekhar Kulkarni.

Treatment:

Dr Chandrashekhar Kulkarni advised, “Various newer therapies like ECMO or Ventricular assist devices can be used in patients who are still waiting on the heart-lung transplant list. Multiple medications that lower the PH are available for control of PPH. It is better to stick to the instructions given by the doctor only. Try to avoid any over-the-counter medication.”

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