Increased pressure in the pulmonary capillary system (pulmonary hypertension, hypertension) is most often a secondary disease not directly related to vascular damage. The primary conditions have not been sufficiently studied, but the role of the vasoconstrictor mechanism, thickening of the arterial wall, and fibrosis (tissue compaction) has been proven.
In accordance with ICD-10 (International Classification of Diseases), only the primary form of pathology is coded as I27.0. All secondary symptoms are added as complications to the underlying chronic disease.
The lungs have a double blood supply: a system of arterioles, capillaries and venules is included in gas exchange. And the tissue itself receives nutrition from the bronchial arteries.
The pulmonary artery is divided into right and left trunks, then into branches and lobar vessels of large, medium and small caliber. The smallest arterioles (part of the capillary network) have a diameter 6–7 times larger than in the systemic circulation. Their powerful muscles are capable of narrowing, completely closing or expanding the arterial bed.
With narrowing, resistance to blood flow increases and internal pressure in the vessels increases; expansion reduces pressure and reduces the force of resistance. The occurrence of pulmonary hypertension depends on this mechanism. The total network of pulmonary capillaries covers an area of 140 m2.
The veins of the pulmonary circle are wider and shorter than those in the peripheral circulation. But they also have a strong muscle layer and are able to influence the pumping of blood towards the left atrium.
Magnitude blood pressure in the pulmonary vessels it is regulated:
Extensive receptor zones are located in large and medium-sized arteries, at branching points, and in veins. Arterial spasm leads to impaired oxygen saturation of the blood. And tissue hypoxia promotes the release of substances into the blood that increase tone and cause pulmonary hypertension.
Irritation of the vagus nerve fibers increases blood flow through the lung tissue. The sympathetic nerve, on the contrary, causes a vasoconstrictor effect. Under normal conditions, their interaction is balanced.
The following indicators of pressure in the pulmonary artery are accepted as the norm:
Pulmonary arterial hypertension, according to international experts, begins at the upper level – 30 mm Hg. Art.
The main factors of pathology, according to V. Parin’s classification, are divided into 2 subtypes. Functional factors include:
Anatomical factors include:
Secondary pulmonary hypertension occurs due to known chronic diseases of the lungs and heart. These include:
Primary pulmonary hypertension is also called idiopathic, isolated. The prevalence of the pathology is 2 people per 1 million inhabitants. The definitive reasons remain unclear.
It has been established that women make up 60% of patients. Pathology is detected both in childhood and in old age, but middle age identified patients - 35 years.
In the development of pathology, 4 factors are important:
The role of the mutating bone protein gene, angioproteins, their influence on the synthesis of serotonin, and increased blood clotting due to the blocking of anticoagulant factors has been established.
A special role is given to infection with the herpes virus type eight, which causes metabolic changes leading to the destruction of arterial walls.
The result is hypertrophy, then expansion of the cavity, loss of right ventricular tone and the development of failure.
There are many causes and lesions that can cause hypertension in the pulmonary circle. Some of them need to be highlighted.
Among acute diseases:
However, pulmonary hypertension can be caused by food, drugs and folk remedies therapy.
Pulmonary hypertension in newborns can be caused by:
In children, hypertension is promoted by enlarged tonsils.
It is convenient for clinicians to divide hypertension in the pulmonary vessels according to the timing of development into acute and chronic forms. Such a classification helps to “combine” the most common causes and clinical course.
Acute hypertension occurs due to:
TO chronic course Pulmonary hypertension is caused by:
A similar development mechanism is typical for:
The following diseases lead to chronic pulmonary hypertension:
Symptoms of pulmonary hypertension appear if the pressure in the pulmonary artery is increased by 2 times or more. Patients with hypertension in the pulmonary circle notice:
The development of decompensation as a result of pulmonary heart failure is accompanied by pain in the right hypochondrium (liver stretching), swelling in the feet and legs.
When examining a patient, the doctor pays attention to the following:
The connection of pulmonary hypertension with permanent causes and certain diseases makes it possible to distinguish clinical course options.
Pulmonary hypertension leads to a simultaneous increase in blood pressure portal vein. In this case, the patient may or may not have cirrhosis of the liver. It accompanies chronic liver diseases in 3–12% of cases. The symptoms are no different from those listed. Swelling and heaviness in the hypochondrium on the right are more pronounced.
The disease varies in severity. Mitral stenosis contributes to the occurrence of atherosclerotic lesions of the pulmonary artery in 40% of patients due to increased pressure on the vessel wall. Functional and organic mechanisms of hypertension are combined.
The narrowed left atrioventricular passage in the heart is the “first barrier” to blood flow. If there is narrowing or blockage of small vessels, a “second barrier” is formed. This explains the failure of surgery to eliminate stenosis in the treatment of heart disease.
By catheterization of the heart chambers, high pressure inside the pulmonary artery is detected (150 mm Hg and above).
Vascular changes progress and become irreversible. Atherosclerotic plaques do not grow to large sizes, but are sufficient to narrow small branches.
The term “pulmonary heart” includes a symptom complex caused by damage to the lung tissue (pulmonary form) or pulmonary artery (vascular form).
There are flow options:
An increase in resistance in the vessels puts a pronounced load on the right heart. General disadvantage oxygen also affects the myocardium. The thickness of the right ventricle increases with the transition to dystrophy and dilatation (persistent expansion of the cavity). Clinical signs of pulmonary hypertension gradually increase.
The crisis often accompanies pulmonary hypertension associated with heart defects. A sharp deterioration in the condition due to a sudden increase in pressure in the pulmonary vessels is possible once a month or more often.
Patients note:
Upon examination, the following is revealed:
Diagnosis of hypertension in the pulmonary circulation is based on identifying its signs. These include:
Russian scientists F. Uglov and A. Popov proposed to distinguish between 4 elevated levels hypertension in the pulmonary artery:
Examination methods used in the diagnosis of hypertrophy of the right chambers of the heart:
More complex methods (radionuclide scintigraphy, angiopulmonography). A biopsy to study the condition of lung tissue and vascular changes is used only in specialized clinics.
When catheterizing the cavities of the heart, not only the pressure is measured, but also the oxygen saturation of the blood is measured. This helps in identifying the causes of secondary hypertension. During the procedure, vasodilators are administered and the reaction of the arteries is checked, which is necessary in the choice of treatment.
Treatment of pulmonary hypertension is aimed at excluding the underlying pathology that caused the increase in pressure.
At the initial stage, anti-asthmatic drugs and vasodilators provide assistance. Folk remedies can further enhance the allergic mood of the body.
If a patient has chronic embolization, the only remedy is surgical removal of the thrombus (embolectomy) by excision from the pulmonary trunk. The operation is carried out in specialized centers; a transition to artificial blood circulation is necessary. Mortality reaches 10%.
Primary pulmonary hypertension is treated with blocker drugs calcium channels. Their effectiveness leads to a decrease in pressure in the pulmonary arteries in 10–15% of patients, accompanied by good review seriously ill patients. This is considered a favorable sign.
An analogue of Prostacyclin, Epoprostenol, is administered intravenously through a subclavian catheter. Inhaled forms of medications (Iloprost), Beraprost tablets orally are used. The effect of subcutaneous administration of a drug such as Treprostinil is being studied.
Bosentan is used to block receptors that cause vasospasm.
At the same time, patients need drugs to compensate for heart failure, diuretics, and anticoagulants.
The use of solutions of Eufillin and No-shpa has a temporary effect.
It is impossible to cure pulmonary hypertension with folk remedies. Recommendations on the use of diuretics and cough suppressants are used very carefully.
You should not get carried away with healing for this pathology. Lost time in diagnosis and initiation of therapy may be lost forever.
Without treatment, the average survival time for patients is 2.5 years. Treatment with Epoprostenol increases the lifespan to five years in 54% of patients. The prognosis of pulmonary hypertension is unfavorable. Patients die from increasing right ventricular failure or thromboembolism.
Patients with pulmonary hypertension due to heart disease and arterial sclerosis live up to 32–35 years of age. The crisis course aggravates the patient’s condition and is regarded as an unfavorable prognosis.
The complexity of the pathology requires maximum attention to cases of frequent pneumonia and bronchitis. Prevention of pulmonary hypertension consists in preventing the development of pneumosclerosis, emphysema, early detection And surgical treatment birth defects.
Pulmonary hypertension (PH) is a syndrome of different diseases, united by a common characteristic symptom - an increase in blood pressure in the pulmonary artery and an increase in the load in the right cardiac ventricle. Inner layer blood vessels grow and interfere with normal blood flow. To move blood into the lungs, the ventricle is forced to contract intensely.
Since the organ is anatomically not adapted to such a load (with PH, the pressure in the pulmonary artery system rises to 25-30 mm Hg), it provokes its hypertrophy (growth) with subsequent decompensation, a sharp decrease in the force of contractions and premature death.
According to the generally accepted classification for coding medical diagnoses, developed by the World Health Organization, disease code according to ICD-10 (latest revision) - I27.0 - primary pulmonary hypertension.
The disease progresses severely, with a pronounced decrease in physical capabilities, heart and pulmonary failure. PH is a rare disease (only 15 cases per million people), but survival is unlikely, especially in the primary form in the later stages, when a person dies, like from cancer, in just six months.
Such rare diseases are called “orphan”: treatment is expensive, there are few drugs (it is not economically profitable to produce them if consumers are less than 1% of the population). But these statistics are of little comfort if the misfortune has affected a loved one.
The diagnosis of “pulmonary hypertension” is established when the pressure parameters in the pulmonary vessels during exercise reach 35 mmHg. Art. Normal blood pressure in the lungs is 5 times lower than in the body as a whole. This is necessary so that the blood has time to become saturated with oxygen and freed from carbon dioxide. When the pressure in the vessels of the lungs increases, it does not have time to receive oxygen, and the brain simply starves and shuts down.
PH is a complex, multivariate pathology. During the manifestation of all its clinical symptoms, damage and destabilization of the cardiovascular and pulmonary systems occurs. Particularly active and running forms(idiopathic PH, PH due to autoimmune damage) lead to system dysfunction with inevitable premature death.
PH can be a solo (primary) form of the disease, or develop after exposure to another underlying cause.
The causes of PH are not fully understood. For example, in the 60s of the last century in Europe, an increase in the disease caused by uncontrolled intake of oral contraceptives and diet pills.
If endothelial function is impaired, the prerequisite may be a genetic predisposition or exposure to external aggressive factors. In each case, this leads to disruption of the metabolic processes of nitric oxide, changes in vascular tone (the appearance of spasms, inflammation), proliferation of the internal walls of blood vessels with a simultaneous reduction in their lumen.
The increased concentration of endothelin (a substance that constricts blood vessels) is explained either by increased secretion in the endothelium or by a decrease in its breakdown in the lungs. The sign is characteristic of idiopathic PH, congenital childhood heart defects, and systemic diseases.
The production or availability of nitric oxide is disrupted, the synthesis of prostacyclin is reduced, the excretion of potassium is increased - any deviation provokes arterial spasm, proliferation of arterial walls, and impaired blood flow in the pulmonary artery.
The following factors can also increase pressure in the pulmonary arteries:
If the exact cause of PH is not established, the disease is diagnosed as primary (congenital).
Based on severity, there are 4 stages of PH:
First clinical symptoms PH manifests itself only after twice the pressure in the pulmonary vessels. The key sign of the disease is shortness of breath, with its own characteristics that make it possible to distinguish it from signs of other diseases:
The remaining symptoms of PH are also common to most patients:
Most often, hypertensive patients come for consultation with complaints of constant shortness of breath, which complicates their usual life. Since primary PH does not have any special signs that make it possible to diagnose PH during the initial examination, the examination is carried out comprehensively - with the participation of a pulmonologist, cardiologist and therapist.
Methods for diagnosing PH:
To avoid mistakes, PH is diagnosed only as a result of studying data from a comprehensive vascular diagnostics. Reasons for visiting the clinic may be:
In the first stages, the disease responds to the proposed therapy. Key guidelines when choosing a treatment regimen should be:
From negative consequences it should be noted:
PH can develop in either mature age, and in infants. This is explained by the characteristics of the lungs of a newborn. When it is born, a strong pressure drop occurs in the arteries of the lungs, caused by the opening of the lungs and the flow of blood.
This factor is a prerequisite for PH in newborns. If with the first breath circulatory system does not reduce pressure in the vessels, decompensation of pulmonary blood flow occurs with changes characteristic of PH.
The diagnosis of “pulmonary hypertension” is established in an infant if the pressure in its vessels reaches 37 mm Hg. Art. Clinically, this type of PH is characterized by the rapid development of cyanosis and severe shortness of breath. For a newborn, this is a critical condition: death usually occurs within a few hours.
There are 3 stages in the development of PH in children:
Each stage can last from 6 months to 6 years - from minimal hemodynamic changes to fatal outcome. And yet, therapeutic measures for young patients are more effective than for adults, since the processes of pulmonary vascular remodeling in children can be prevented and even reversed.
The prognosis for the treatment of pulmonary hypertension in most cases is unfavorable: 20% of recorded cases of PH resulted in premature death. The type of pulmonary hypertension is also an important factor.
In the secondary form, which develops as a result of autoimmune failures, the statistics are the worst: 15% of patients die due to deficiency within a few years after diagnosis. The life expectancy of this category of hypertensive patients is influenced by the average blood pressure in the lungs. If it is kept at 30 mmHg. Art. and higher and does not respond to treatment measures, life expectancy is reduced to 5 years.
An important circumstance will be the time of joining pulmonary insufficiency also heartfelt. Idiopathic (primary) pulmonary hypertension has poor survival. It is extremely difficult to treat, and average duration life for this category of patients is 2.5 years.
Simple measures will help minimize the risk of developing such a formidable disease:
If your child faints at school or your grandmother has unusual shortness of breath, do not delay visiting a doctor. Modern drugs and treatment methods can significantly reduce clinical manifestations diseases, improve the quality of life, increase its duration. The earlier the disease is detected, the more carefully all the doctor’s instructions are followed, the greater the chance of defeating the disease.
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Heart problems occur for various reasons. An increase in pressure in the pulmonary artery is one of them. This disorder at stages 1 and 2 has almost no symptoms and signs, but requires compulsory treatment– only in this case there will be a positive prognosis for a person’s life.
Contrary to the name, the disease “pulmonary hypertension” does not involve problems with the lungs at all, but with the heart, when the blood pressure of the pulmonary artery and the vessels coming from it increases. Most often, the pathology is provoked by other heart problems; in rare cases, it is considered as a primary pathology.
For this part of the circulatory system normal pressure is a value up to 25/8 millimeters of mercury (systolic/diastolic). Hypertension is indicated when the values rise above 30/15.
Analyzing medical statistics, we can say that pulmonary hypertension is rare, but even its 1st degree is very dangerous, which must be treated, otherwise the life prognosis is unfavorable and a sharp increase in pressure can result in the death of the patient.
Photo 1. Pulmonary artery in normal conditions and with hypertension
The causes of the disease are a decrease in the internal diameter of the vessels of the lungs, since the endothelium, which is the internal vascular layer, grows excessively in them. As a result of impaired blood flow, the supply of blood to remote areas of the body and limbs deteriorates, which has certain symptoms and signs, which we will discuss below.
The heart muscle, receiving appropriate signals, compensates these deficiencies begin to work and contract more intensely. When such a pathological problem exists, the muscle layer in the right ventricle thickens, which leads to an imbalance in the functioning of the entire heart. This phenomenon even received a separate name - cor pulmonale.
Pulmonary hypertension can be detected using electrocardiograms, however, for an early degree, the changes will be insignificant and may be missed, therefore, for accurate diagnosis and timely treatment, older people need to know what pulmonary hypertension is, its signs and symptoms. Only in this case can the disease be identified and treated in a timely manner, maintaining a good prognosis for life.
Pulmonary hypertension according to the international classification of diseases ICD-10 belongs to the class - I27.
To date, the exact cause of the disease has not been identified. Abnormal endothelial growth is often associated with internal imbalances in the body, due to poor nutrition and the intake of elements such as potassium and sodium. Specified chemicals are responsible for the narrowing and dilation of blood vessels; if they are deficient, vascular spasm may occur.
Another common cause of pulmonary hypertension is a hereditary factor. The presence of pathology in one of the blood relatives should be the reason for a narrow examination and, if necessary, treatment for early stage when symptoms have not yet appeared.
Often disturbances appear in other heart diseases - congenital defect heart, obstructive pulmonary disease and others. In such cases, pulmonary hypertension is diagnosed as a complication and it is necessary to influence first of all its root cause.
A proven reason is the consumption of special amino acids that affect the growth of endothelium. Several decades ago, it was noted that consumption of rapeseed oil, which contains these amino acids, led to an increase in cases of the disease. As a result, studies were conducted that confirmed that rapeseed contains high concentration tryptophan, which causes mild pulmonary hypertension and increases the risk severe consequences.
In some cases, the reasons lie in the application hormonal drugs contraception, drugs for sudden weight loss and other means leading to disruption of the internal functionality of the human body.
Finding out about pulmonary hypertension at an early stage is a great success, since in most situations there are no obvious symptoms. However, if you take a closer look and listen to yourself, you can detect some signs of moderate hypertension.
Main symptoms These are reduced physical capabilities when a person constantly feels general weakness, for which there are no obvious reasons. Often, when undergoing an examination, the disease in question is discovered at different stages. Let's look at the different degrees of pulmonary hypertension, what symptoms they differ in, what they threaten and what treatment they require.
Pulmonary hypertension stage 1 the only difference is rapid heartbeat, an experienced doctor is able to detect it on an ECG and send it for additional testing of the pulmonary vessels. Stage 2 pulmonary hypertension It is characterized by more obvious symptoms, which cannot be ignored and it is important to immediately visit a cardiologist or therapist.
It is very important to detect violations as far as possible early stage. It is difficult to do this, but, ultimately, the prognosis of life depends on this, and how long the patient will live.
The process of making a diagnosis is no less important, since it is very easy to miss the disease at an early stage of development. Pulmonary hypertension is first visible on the ECG. This procedure serves as the starting point for the detection and treatment of this disease.
The cardiogram will show abnormal functioning of the cardiac myocardium, which is the first reaction of the heart to problems of a pulmonary nature. If we consider the diagnostic process as a whole, it consists of the following stages:
Detecting pathology is a difficult task, but treating hypertension is no easier. The effectiveness of treatment is largely determined by the stage of development; in the first stages, there are methods of conservative therapy with the help of drugs; with serious development, when the prognosis is poor, there is a threat to life and it is impossible to recover medicines, surgery is prescribed.
The treatment is carried out by a cardiologist. Once symptoms are detected and confirmed, the first step is to reduce the likelihood of severe consequences that accompany pulmonary hypertension. To do this you need:
Psychologically, the patient also needs additional help, since treatment and subsequent life often have to be completely changed in order to avoid risky situations. If this disease is secondary complication other pathology, then therapy is required primarily by the underlying ailment.
Conservative treatment of pulmonary hypertension itself sometimes continues for several years when it is necessary to regularly take a complex of prescribed medications that suppress the progression of endothelial proliferation. During this period, the patient should take:
Surgery is used in conditions where pulmonary hypertension is caused, for example, by cyanotic heart disease, which cannot be treated by other means.
As a surgical therapy, balloon atrial septostomy is performed, when the septum between the atria is cut and expanded special cylinder. Thanks to this, the supply of oxygenated there's blood coming out V right atrium, which reduces the symptoms and severity of pulmonary hypertension.
At the very severe course a lung or heart transplant may be required. Such an operation is very complex, has a lot of restrictions, and there are great difficulties in finding donor organs, especially in Russia, however modern medicine able to carry out such manipulations.
Preventive measures to prevent pulmonary hypertension are very important. This is especially true people at risk– in the presence of a heart defect, if there are relatives with the same disease, after 40-50 years. Prevention consists of maintaining a healthy lifestyle, in particular it is important:
It is impossible to say exactly how long people with this disease live. With a moderate degree and compliance with all recommendations of the cardiologist, pulmonary hypertension has a positive prognosis.
The primary conditions have not been sufficiently studied, but the role of the vasoconstrictor mechanism, thickening of the arterial wall, and fibrosis (tissue compaction) has been proven.
In accordance with ICD-10 (International Classification of Diseases), only the primary form of pathology is coded as I27.0. All secondary symptoms are added as complications to the underlying chronic disease.
The lungs have a double blood supply: a system of arterioles, capillaries and venules is included in gas exchange. And the tissue itself receives nutrition from the bronchial arteries.
The pulmonary artery is divided into right and left trunks, then into branches and lobar vessels of large, medium and small caliber. The smallest arterioles (part of the capillary network) have a diameter 6–7 times larger than in the systemic circulation. Their powerful muscles are capable of narrowing, completely closing or expanding the arterial bed.
With narrowing, resistance to blood flow increases and internal pressure in the vessels increases; expansion reduces pressure and reduces the force of resistance. The occurrence of pulmonary hypertension depends on this mechanism. The total network of pulmonary capillaries covers an area of 140 m2.
The veins of the pulmonary circle are wider and shorter than those in the peripheral circulation. But they also have a strong muscle layer and are able to influence the pumping of blood towards the left atrium.
The amount of blood pressure in the pulmonary vessels is regulated by:
Extensive receptor zones are located in large and medium-sized arteries, at branching points, and in veins. Arterial spasm leads to impaired oxygen saturation of the blood. And tissue hypoxia promotes the release of substances into the blood that increase tone and cause pulmonary hypertension.
Irritation of the vagus nerve fibers increases blood flow through the lung tissue. The sympathetic nerve, on the contrary, causes a vasoconstrictor effect. Under normal conditions, their interaction is balanced.
The following indicators of pressure in the pulmonary artery are accepted as the norm:
Pulmonary arterial hypertension, according to international experts, begins at the upper level – 30 mm Hg. Art.
The main factors of pathology, according to V. Parin’s classification, are divided into 2 subtypes. Functional factors include:
Anatomical factors include:
Secondary pulmonary hypertension occurs due to known chronic diseases of the lungs and heart. These include:
Primary pulmonary hypertension is also called idiopathic, isolated. The prevalence of the pathology is 2 people per 1 million inhabitants. The definitive reasons remain unclear.
It has been established that women make up 60% of patients. Pathology is detected both in childhood and in old age, but the average age of identified patients is 35 years.
In the development of pathology, 4 factors are important:
The role of the mutating bone protein gene, angioproteins, their influence on the synthesis of serotonin, and increased blood clotting due to the blocking of anticoagulant factors has been established.
A special role is given to infection with the herpes virus type eight, which causes metabolic changes leading to the destruction of arterial walls.
The result is hypertrophy, then expansion of the cavity, loss of right ventricular tone and the development of failure.
There are many causes and lesions that can cause hypertension in the pulmonary circle. Some of them need to be highlighted.
Among acute diseases:
In this case, pulmonary hypertension can be caused by foods, drugs and folk remedies.
Pulmonary hypertension in newborns can be caused by:
In children, hypertension is promoted by enlarged tonsils.
It is convenient for clinicians to divide hypertension in the pulmonary vessels according to the timing of development into acute and chronic forms. Such a classification helps to “combine” the most common causes and clinical course.
Acute hypertension occurs due to:
The chronic course of pulmonary hypertension is caused by:
A similar development mechanism is typical for:
The following diseases lead to chronic pulmonary hypertension:
Symptoms of pulmonary hypertension appear if the pressure in the pulmonary artery is increased by 2 times or more. Patients with hypertension in the pulmonary circle notice:
The development of decompensation as a result of pulmonary heart failure is accompanied by pain in the right hypochondrium (liver stretching), swelling in the feet and legs.
When examining a patient, the doctor pays attention to the following:
The association of pulmonary hypertension with persistent causes and certain diseases makes it possible to distinguish variants in the clinical course.
Pulmonary hypertension leads to a simultaneous increase in portal vein pressure. In this case, the patient may or may not have cirrhosis of the liver. It accompanies chronic liver diseases in 3–12% of cases. The symptoms are no different from those listed. Swelling and heaviness in the hypochondrium on the right are more pronounced.
The disease varies in severity. Mitral stenosis contributes to the occurrence of atherosclerotic lesions of the pulmonary artery in 40% of patients due to increased pressure on the vessel wall. Functional and organic mechanisms of hypertension are combined.
The narrowed left atrioventricular passage in the heart is the “first barrier” to blood flow. If there is narrowing or blockage of small vessels, a “second barrier” is formed. This explains the failure of surgery to eliminate stenosis in the treatment of heart disease.
By catheterization of the heart chambers, high pressure inside the pulmonary artery is detected (150 mm Hg and above).
Vascular changes progress and become irreversible. Atherosclerotic plaques do not grow to large sizes, but they are sufficient to narrow small branches.
The term “pulmonary heart” includes a symptom complex caused by damage to the lung tissue (pulmonary form) or pulmonary artery (vascular form).
There are flow options:
An increase in resistance in the vessels puts a pronounced load on the right heart. The general lack of oxygen also affects the myocardium. The thickness of the right ventricle increases with the transition to dystrophy and dilatation (persistent expansion of the cavity). Clinical signs of pulmonary hypertension gradually increase.
The crisis often accompanies pulmonary hypertension associated with heart defects. A sharp deterioration in the condition due to a sudden increase in pressure in the pulmonary vessels is possible once a month or more often.
Upon examination, the following is revealed:
Diagnosis of hypertension in the pulmonary circulation is based on identifying its signs. These include:
Russian scientists F. Uglov and A. Popov proposed to distinguish between 4 elevated levels of hypertension in the pulmonary artery:
Examination methods used in the diagnosis of hypertrophy of the right chambers of the heart:
More complex methods (radionuclide scintigraphy, angiopulmonography). A biopsy to study the condition of lung tissue and vascular changes is used only in specialized clinics.
When catheterizing the cavities of the heart, not only the pressure is measured, but also the oxygen saturation of the blood is measured. This helps in identifying the causes of secondary hypertension. During the procedure, vasodilators are administered and the reaction of the arteries is checked, which is necessary in the choice of treatment.
Treatment of pulmonary hypertension is aimed at excluding the underlying pathology that caused the increase in pressure.
At the initial stage, anti-asthmatic drugs and vasodilators provide assistance. Folk remedies can further enhance the allergic mood of the body.
If a patient has chronic embolization, the only remedy is surgical removal of the thrombus (embolectomy) by excision from the pulmonary trunk. The operation is carried out in specialized centers; a transition to artificial blood circulation is necessary. Mortality reaches 10%.
Primary pulmonary hypertension is treated with calcium channel blockers. Their effectiveness leads to a decrease in pressure in the pulmonary arteries in 10–15% of patients, and is accompanied by good response from seriously ill patients. This is considered a favorable sign.
An analogue of Prostacyclin, Epoprostenol, is administered intravenously through a subclavian catheter. Inhaled forms of medications (Iloprost), Beraprost tablets orally are used. The effect of subcutaneous administration of a drug such as Treprostinil is being studied.
Bosentan is used to block receptors that cause vasospasm.
At the same time, patients need drugs to compensate for heart failure, diuretics, and anticoagulants.
The use of solutions of Eufillin and No-shpa has a temporary effect.
It is impossible to cure pulmonary hypertension with folk remedies. Recommendations on the use of diuretics and cough suppressants are used very carefully.
You should not get carried away with healing for this pathology. Lost time in diagnosis and initiation of therapy may be lost forever.
Without treatment, the average survival time for patients is 2.5 years. Treatment with Epoprostenol increases the lifespan to five years in 54% of patients. The prognosis of pulmonary hypertension is unfavorable. Patients die from increasing right ventricular failure or thromboembolism.
Patients with pulmonary hypertension due to heart disease and arterial sclerosis live up to 32–35 years of age. The crisis course aggravates the patient’s condition and is regarded as an unfavorable prognosis.
The complexity of the pathology requires maximum attention to cases of frequent pneumonia and bronchitis. Prevention of pulmonary hypertension consists of preventing the development of pneumosclerosis, emphysema, early detection and surgical treatment of congenital defects.
Pulmonary hypertension (PH) is a syndrome of different diseases, united by a common characteristic symptom - an increase in blood pressure in the pulmonary artery and an increase in the load in the right cardiac ventricle. The inner layer of blood vessels grows and interferes with normal blood flow. To move blood into the lungs, the ventricle is forced to contract intensely.
Since the organ is anatomically not adapted to such a load (with PH, the pressure in the pulmonary artery system rises by a dozen Hg), it provokes its hypertrophy (growth) with subsequent decompensation, a sharp decrease in the force of contractions and premature death.
According to the generally accepted classification for coding medical diagnoses developed by the World Health Organization, the disease code according to ICD-10 (latest revision) is I27.0 - primary pulmonary hypertension.
The disease progresses severely, with a pronounced decrease in physical capabilities, heart and pulmonary failure. PH is a rare disease (only 15 cases per million people), but survival is unlikely, especially in the primary form in the later stages, when a person dies, like from cancer, in just six months.
Such rare diseases are called “orphan”: treatment is expensive, there are few drugs (it is not economically profitable to produce them if consumers are less than 1% of the population). But these statistics are of little comfort if the misfortune has affected a loved one.
The diagnosis of “pulmonary hypertension” is established when the pressure parameters in the pulmonary vessels during exercise reach 35 mmHg. Art. Normally, blood pressure in the lungs is 5 times lower than in the body as a whole. This is necessary so that the blood has time to become saturated with oxygen and freed from carbon dioxide. When the pressure in the vessels of the lungs increases, it does not have time to receive oxygen, and the brain simply starves and shuts down.
PH is a complex, multivariate pathology. During the manifestation of all its clinical symptoms, damage and destabilization of the cardiovascular and pulmonary systems occurs. Particularly active and advanced forms (idiopathic PH, PH with autoimmune damage) lead to system dysfunction with inevitable premature death.
PH can be a solo (primary) form of the disease, or develop after exposure to another underlying cause.
The causes of PH are not fully understood. For example, in the 60s of the last century in Europe there was an increase in the disease caused by the uncontrolled use of oral contraceptives and diet pills.
If endothelial function is impaired, the prerequisite may be a genetic predisposition or exposure to external aggressive factors. In each case, this leads to disruption of the metabolic processes of nitric oxide, changes in vascular tone (the appearance of spasms, inflammation), proliferation of the internal walls of blood vessels with a simultaneous reduction in their lumen.
The increased concentration of endothelin (a substance that constricts blood vessels) is explained either by increased secretion in the endothelium or by a decrease in its breakdown in the lungs. The sign is characteristic of idiopathic PH, congenital childhood heart defects, and systemic diseases.
The production or availability of nitric oxide is disrupted, the synthesis of prostacyclin is reduced, the excretion of potassium is increased - any deviation provokes arterial spasm, proliferation of arterial walls, and impaired blood flow in the pulmonary artery.
The following factors can also increase pressure in the pulmonary arteries:
If the exact cause of PH is not established, the disease is diagnosed as primary (congenital).
Based on severity, there are 4 stages of PH:
The first clinical symptoms of PH appear only after the pressure in the pulmonary vessels has doubled. The key sign of the disease is shortness of breath, with its own characteristics that make it possible to distinguish it from signs of other diseases:
The remaining symptoms of PH are also common to most patients:
Most often, hypertensive patients come for consultation with complaints of constant shortness of breath, which complicates their usual life. Since primary PH does not have any special signs that make it possible to diagnose PH during the initial examination, the examination is carried out comprehensively - with the participation of a pulmonologist, cardiologist and therapist.
Methods for diagnosing PH:
To avoid mistakes, PH is diagnosed only as a result of studying data from a comprehensive vascular diagnostics. Reasons for visiting the clinic may be:
In the first stages, the disease responds to the proposed therapy. Key guidelines when choosing a treatment regimen should be:
Among the negative consequences it should be noted:
PH can develop both in adulthood and in infants. This is explained by the characteristics of the lungs of a newborn. When it is born, a strong pressure drop occurs in the arteries of the lungs, caused by the opening of the lungs and the flow of blood.
This factor is a prerequisite for PH in newborns. If the circulatory system does not reduce the pressure in the vessels with the first breath, decompensation of pulmonary blood flow occurs with changes characteristic of PH.
The diagnosis of “pulmonary hypertension” is established in an infant if the pressure in its vessels reaches 37 mm Hg. Art. Clinically, this type of PH is characterized by the rapid development of cyanosis and severe shortness of breath. For a newborn, this is a critical condition: death usually occurs within a few hours.
There are 3 stages in the development of PH in children:
Each stage can last from 6 months to 6 years - from minimal hemodynamic changes to death. And yet, therapeutic measures for young patients are more effective than for adults, since the processes of pulmonary vascular remodeling in children can be prevented and even reversed.
The prognosis for the treatment of pulmonary hypertension in most cases is unfavorable: 20% of recorded cases of PH resulted in premature death. The type of pulmonary hypertension is also an important factor.
In the secondary form, which develops as a result of autoimmune failures, the statistics are the worst: 15% of patients die due to deficiency within a few years after diagnosis. The life expectancy of this category of hypertensive patients is influenced by the average blood pressure in the lungs. If it is kept at 30 mmHg. Art. and higher and does not respond to treatment measures, life expectancy is reduced to 5 years.
An important circumstance will be the time when cardiac failure also joins pulmonary failure. Idiopathic (primary) pulmonary hypertension has poor survival. It is extremely difficult to treat, and the average life expectancy for this category of patients is 2.5 years.
Simple measures will help minimize the risk of developing such a formidable disease:
If your child faints at school or your grandmother has unusual shortness of breath, do not delay visiting a doctor. Modern drugs and treatment methods can significantly reduce the clinical manifestations of the disease, improve the quality of life, and increase its duration. The earlier the disease is detected, the more carefully all the doctor’s instructions are followed, the greater the chance of defeating the disease.
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Secondary pulmonary hypertension- increased pressure in the pulmonary artery (acquired) of more than 20 mm Hg. Art. at rest and more than 30 mm Hg. Art. under load.
Code according to the international classification of diseases ICD-10:
X-ray of the chest organs. Important for identifying parenchymal lung diseases. Allows you to identify the expansion of the pulmonary artery trunk and the roots of the lungs. The expansion of the right descending branch of the pulmonary artery is more than 16-20 mm.
ECG. A normal ECG does not exclude pulmonary hypertension. P - pulmonale. EOS deviation to the right. Signs of right ventricular hypertrophy (high R waves in leads V1-3 and deep S waves in leads V5-6). Signs of blockade right leg Heath bundle.
Ventilation-perfusion lung scintigraphy is important for diagnosing pulmonary embolism.
Jugular phlebography. High-amplitude A wave with compensated right ventricular hypertrophy. High-amplitude wave V in right ventricular failure.
Study of lung functions. Decreased functional capacity of the lungs. A change in the ventilation/perfusion ratio suggests embolism in the proximal pulmonary arteries.
Cardiac catheterization is important for the diagnosis of left ventricular dysfunction and heart defects, as well as for direct measurement of pressure in the pulmonary vessels. Pulmonary artery pressure (PAP) is increased. Pulmonary artery wedge pressure (PAWP) is normal or increased. Pulmonary vascular resistance (PVR) is calculated using Wood's formula: [PVR = (PAP average - PPV)/CO], where CO is cardiac output. The SLS determines the severity of pulmonary hypertension: mild - 2-5 units, moderate - 5-10 units, severe - more than 10 units.
Liver biopsy - if liver cirrhosis is suspected.
ICD-10. I28. 8 Other specified pulmonary vascular diseases
