Pulmonary Hypertension - Symptoms, Risk factors and Treatment

Pulmonary hypertension is a condition in which the blood pressure in the arteries of your lungs is raised. It is a type of hypertension that is different from systemic hypertension-in which the blood pressure is raised in all the arteries of your body.

Understanding the normal functioning of the heart and lungs

Your heart has four chambers, and two sides. The left side and the right side. The right side of the heart pumps blood to your lungs to receive oxygen, while the left side of your heart receives that blood from the lungs and pumps it to the whole body. 

Your lungs receive oxygen-poor blood from the right side of the heart via the pulmonary artery. In the lungs, the blood receives oxygen and becomes oxygen-rich, and is then carried to the left side of your heart via the pulmonary vein.

If due to any cause (as discussed later), the blood pressure in the pulmonary arteries becomes high, the right side of your heart has to pump harder to push the blood against high pressure. It results in enlargement of the right side of your heart- a condition medically referred to as “Cor Pulmonale”.

Symptoms of Pulmonary Hypertension

Symptoms of pulmonary hypertension may include:

• Breathlessness on exertion
• Fatigue
• Weakness
• Coughing
• Breathlessness on lying down
• Weight gain
• Swollen ankles, feet, or legs
• Loss of appetite
• Bluish lips 

Causes of Pulmonary Hypertension

Any problem in the normal pathway (as explained above), can result in pulmonary hypertension. Any narrowing or disease in the heart, lungs, or the vessels connecting the two organs or diseases of other organs can ultimately result in pulmonary hypertension. 

The World Health Organization (WHO) has divided pulmonary hypertension into five different groups based on the underlying cause.

1. Pulmonary Arterial Hypertension: 

It is due to the narrowing of the pulmonary artery which increases the pressure in the vessel. 

It could be due to:

• Unknown cause (Idiopathic)
• Familial HIV
• Some drugs
• Congenital heart disease (birth-defect in the heart)

2. Pulmonary hypertension due to left-sided heart failure:

When the left ventricle does not work properly, the blood will pool back into the lungs, and the pressure inside the lungs will increase subsequently.

 The causes of this type of pulmonary hypertension may include:

• Severe aortic disease
• Chronic left ventricular heart failure 
• Severe mitral disease
• Congenital disorders

3. Pulmonary hypertension due to chronic thromboembolic disease:

Thromboembolism-a clot in the pulmonary vessels will block the normal flow of blood forward resulting in increased pressure.

4. Pulmonary hypertension due to lung disease or hypoxemia:

Hypoxemia means the low concentration of oxygen in your blood. Your body responds to hypoxemia by narrowing the blood vessels, known as vasoconstriction, which increases blood pressure.

The causes for this may include:

• Chronic obstructive pulmonary disease (COPD)
• Interstitial lung disease 
• Developmental lung disease 
• Sleep apnea 
• Chronic exposure to high altitude 
• Hypoventilation syndrome
• Lung cancer

Multifactorial pulmonary hypertension:

Many other diseases can result in pulmonary hypertension. These may include:

• Blood disorders
• Sarcoidosis and other systemic disorders
• Liver cirrhosis 
• Chronic renal failure
• Compression of pulmonary vessels(as in tumors)
• Other causes

Risk factors of pulmonary hypertension 

The risk factors for pulmonary hypertension can be as follows.

• Congestive heart failure
• Family history 
• Systemic lupus erythematosus
• Drug-induced 
• Respiratory diseases like emphysema, chronic bronchitis, and pulmonary fibrosis 
• Sleep apnea
• Cirrhosis 
• Kidney disease
• Infections 

Conclusion 

Pulmonary hypertension is a condition in which the blood pressure of the pulmonary vessels remains elevated. It most commonly shows the signs and symptoms of cough and breathlessness. Therefore if you have the same complaint, you should visit the doctor soon.