Pulmonary hypertension is an umbrella term that encompasses many causes of high blood pressure within the lung arteries. It means that the heart is having to pump blood harder to get it through the lungs. “Pulmonary” refers to the lungs and “hypertension” means high blood pressure. Arteries are the blood vessels that carry oxygenated blood from the lungs to the rest of the body.
When pulmonary hypertension occurs, the lung’s arteries are narrowed and hardened, making it more difficult for the heart to pump blood through them. One serious risk of the condition is that this extra effort will eventually weaken the heart and cause it to fail.
Causes of Pulmonary Hypertension
There are many different causes of pulmonary hypertension, and they are all quite different from one another. One condition is idiopathic pulmonary hypertension where higher blood pressure is only found in the lung arteries. This condition is typically diagnosed in younger people and seemingly occurs out of the blue. The main symptom is gradually increasing breathlessness (dyspnea), which can be difficult to diagnose.
Diseases of the heart and lungs, as well as blood clots in the lungs’ arteries, can also cause pulmonary hypertension, as can congenital heart disease and other conditions like chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. In many of these conditions, pulmonary hypertension develops over the years; thus, damage can go undetected until symptoms become extreme. In addition to heart failure, pulmonary hypertension may lead to blood clots, stroke, arrhythmia, and bleeding in the lungs, among other risks.
Symptoms of Pulmonary Hypertension
The most striking feature of pulmonary hypertension, whatever its cause, is unexplained breathlessness. Initially, breathlessness occurs during exercise; as the disease worsens, it will be experienced at rest as well. Additional symptoms include fatigue, dizziness, fainting (syncope), chest pain or pressure, a racing pulse or palpitations, swelling in the ankles (edema), and a bluish tinge to the lips or skin (cyanosis).
There are four classes of pulmonary hypertension, depending on the severity of symptoms. They range from Class I (no symptoms) to Class IV (symptoms even when at rest).
Multiple factors can put some people more at risk of developing pulmonary hypertension. These include a family history of the condition, being overweight, living at a high altitude, exposure to asbestos, illegal drug use (such as cocaine), and the use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression.
Diagnosis of Pulmonary Hypertension
As mentioned above, pulmonary hypertension can be hard to diagnose. Symptoms develop gradually and present like many other conditions affecting the heart and lungs. Generally, other conditions are eliminated first through diagnostic tests.
Diagnostic tests that may be used to detect pulmonary hypertension include chest x-rays, blood work, echocardiogram, electrocardiogram (ECG), and catheterization into the right side of the heart. Additionally, tests such as computerized tomography (CT) scan, magnetic resonance imaging scan (MRI) or a biopsy can help determine the cause of pulmonary hypertension, once detected.
Treatment of Pulmonary Hypertension
Pulmonary hypertension cannot be cured, but the symptoms can be treated. Treatments are usually complex and multifaceted requiring frequent follow-up.
Vasodilators are commonly prescribed for pulmonary hypertension. Vasodilators relax narrowed blood vessels, allowing more blood through and reducing the burden on the heart. This medication comes in various forms - it can be ingested in pill form, but it can also be injected, inhaled, or delivered through a nebulizer or by IV. Additional drugs that relax blood vessels may also be prescribed.
Warfarin, an anti-coagulating medication or a blood-thinner, is also used to treat pulmonary hypertension. While it reduces the chance of developing blood clots in the lungs, it can lead to an increased risk of bleeding. Diuretics (“water pills”) help the kidneys flush toxins from the body and may be prescribed to relieve the burden on the heart as well.
Physicians may prescribe oxygen treatments for patients with pulmonary hypertension. Open heart surgery or a heart or lung transplant may be considered in the most serious cases.
Managing Pulmonary Hypertension
While pulmonary hypertension is a chronic condition, certain lifestyle changes may lessen symptoms. These include getting enough rest to manage fatigue and staying active when possible. Even if walking is the most strenuous activity one can tolerate, this moderate exercise has been found to be helpful.
Eating a healthy diet and regularly checking in with a physician are also recommended. People with pulmonary hypertension should avoid living in or traveling to places with high altitudes. They should also avoid situations that may drastically lower blood pressure, such as taking long hot showers or using saunas or hot tubs.