Causes and risk factors
Pulmonary hypertension can be caused due to several disease conditions, such as congestive heart failure, pulmonary embolism, pulmonary fibrosis, HIV infection, liver cirrhosis and emphysema.
Other causes include rheumatoid arthritis, lupus, scleroderma, sleep apnea and congenital heart defects. High altitudes and illicit use of drugs such as cocaine can also lead to pulmonary hypertension.
In some cases no cause can be found; it is called as idiopathic pulmonary hypertension.
Clinical presentation
Pulmonary hypertension produces a dry cough, chest pain and breathlessness, especially on exertion. The person may feel dizzy and tired and experience palpitations. Cyanosis may be seen. The patient may have edema over lower extremities or over the abdomen (ascites).
Pulmonary hypertension can give rise to complications such as haemoptysis, cor-pulmonale, formation of blood clots and irregular heartbeats.
Diagnosis & Investigations
Based upon your symptoms, your doctor will perform physical examination and order investigations to confirm the diagnosis of pulmonary hypertension.
During physical examination your doctor will listen to heart sounds and look for signs such as edema over lower limbs, ascites, clubbing and cyanosis.
Certain investigations need to be carried out which include chest X-ray, electrocardiogram and echocardiogram. Pulmonary function tests are done to check the lung’s functioning. Stress test is performed to check the capacity of the heart to tolerate physical exertion. Blood tests for HIV or any other underlying disease must be carried out. CT scan or MRI scan of the chest are needed to view the heart and lungs in detail.
Right heart catheterization may be performed. In this procedure, a thin and flexible tube is introduced into the heart. Through this tube, the functioning of the heart can be assessed.
Treatment
Currently pulmonary hypertension is not curable. Treatment is aimed at reducing the symptoms and preventing the development of complications. In cases where definite cause is present, treatment is directed towards removing the cause.
The patient is advised to make certain lifestyle changes. Maintain a healthy weight. Eat a balanced, nutritious diet. Exercise regularly. Do not smoke or drink. Keep stress at bay. Avoid high altitudes.
The medications prescribed may include blood vessel dilators, endothelin receptor antagonists, sedatives, blood thinners, calcium channel blockers and diuretics. Oxygen therapy may be done to increase oxygen level in the blood.
Sometimes, surgical intervention becomes mandatory. Lung or heart-lung transplantation especially indicated in cases which do not respond to conservative measures and in idiopathic cases. Atrial septostomy is done to reduce the pressure over the right side of the heart.
