Pulmonary hypertension: what is it, symptoms, and treatment, prognosis
In medical practice, registered a condition in which increased pulmonary pressure, leading to narrowing of the lumen of small vessels of the lungs. Such violations gradually increase, worsen and further lead to failure of the right ventricle of the heart. This article describes this pulmonary hypertension, States that it is like clinically, and how treated.
Under the influence of various factors there is a thickening of the walls of the branches of the pulmonary artery that leads to narrowing of the lumen. This increases the blood pressure in the pulmonary artery and the right ventricle has to contract with greater force, which further becomes the cause of the hypertrophy and the development of right heart failure. The etiological factor of pulmonary hypertension (PH) are not clearly established, but it is possible to allocate the following reasons that can cause an increase in pulmonary pressure:
- Genetic disorders in the organism that lead to the development of primary (idiopathic) LH. Primary hypertension develops as an independent disease and is associated with impaired Central regulation of vascular tone. It is also believed that idiopathic hypertension may occur in congenital disorders of secretion of substances that constrict blood vessels (e.g., serotonin) or in the event of changes of platelet aggregation with formation of microthrombi in the pulmonary vessels.
- Diseases of other organ systems (secondary LG).
Among the pathologies that can increase the pressure in the pulmonary artery, it should be called:
- heart disease (coronary artery disease, arterial hypertension, myocarditis, cardiomyopathy, mitral stenosis);
- pathology of the lungs with chronic obstruction, lichen processes, diffuse pnevmonity and fibrosis, and status asthmaticus and respiratory distress syndrome;
- in newborns cause of pulmonary hypertension can be a diaphragmatic hernia, maintaining fetal circulation, meconium aspiration, congenital anomalies;
- a state of hypoxia or hypercapnia, which is most often observed when staying in the highlands, with upper airway obstruction (for example, with a significant increase of the tonsils), as well as primary alveolar hypoventilation.
In addition, it should be noted some favorable factors, the effects of which pulmonary hypertension is logged frequently:
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- effects of toxins and certain medicines that adversely affect lung tissue (e.g., amphetamine, antidepressants and drugs that suppress appetite);
- HIV infection;
- cirrhosis of the liver;
- neoplastic diseases of the blood;
- compression of pulmonary blood vessels due to obesity or chest wall deformity.
The types of LG
The pulmonary artery pressure is measured when conducting an echocardiogram (ultrasound) or by cardiac catheterization. Classification according to the degree of its increase:
- LH 1 degree is manifested by the increased pressure to 45 mm Hg. article;
- the 2nd stage indicators can grow up to 65 mm of mercury. article;
- about 3 much say in the cases when the pressure rises above 65 mm Hg. article
There are also 4 classes of LH, depending on the severity of the leak and volume of functional disorders. In addition, possible residual LH. It is registered among infants and is characterized by a significant increase in the pressure in the pulmonary vessels against a background of severe hypoxia and blood shunting from right to left through the ductus arteriosus and the foramen ovale in the heart.
Obvious clinical manifestations of the disease are observed when the pressure in the pulmonary artery increases twice or even more. Reasonable LH may be asymptomatic, which is quite dangerous. The initial complaint of patients become short of breath with little exertion and at rest. Patients reported asthenia, weight loss in normal nutrition. Subsequently, there is a dry cough and abdominal discomfort, which may be attributed to stagnation in the portal vein. Also, hypertension of the lungs manifested by dizziness and loss of consciousness due to brain hypoxia, tachycardia and throbbing jugular vein that can be visually seen in the neck.
With the progression of pathological changes appears hemoptysis, indicating the development of pulmonary edema. There are attacks of angina pectoris and other signs of myocardial ischemia, disturbed rhythm of the heart in the form of atrial arrhythmias. When the syndrome of pulmonary hypertension was accompanied by a stagnation in the big circle of blood circulation, appear pain in the right hypochondrium, otmechayut feet, may develop ascites. In addition, in the terminal stages of clots formed in the pulmonary vessels. This is a very high probability of pulmonary embolism and fatal completion of the disease.
Persistent form of LH diagnosed shortly after birth. Characterized by cyanosis, which is accompanied by respiratory disorders. The examination in children detect cardiomegaly, heart murmurs, liver enlargement, signs of severe hypoxemia and shock.
Principles of treatment
Non-pharmacological treatment includes the regulation of food and fluid intake, restriction of physical activity, with the exception of Hiking in the mountains. Maintenance treatment with the use of the following medications:
- Diuretics help to remove excess liquid, eliminate swelling and reduce the workload on the heart. At their reception be sure to monitor blood electrolytes (in case of overdose of diuretics possible convulsions and arrhythmias due to excessive potassium loss and calcium).
- Anticoagulants and thrombolytics – dissolve the formed thrombi and prevent their re-formation.
- Cardiac glycosides improve heart function, eliminate arrhythmia and shortness of breath.
- Vasodilator drugs help relax the muscles of the vascular wall, which leads to an increase of the lumen and improve blood flow.
- Prostaglandins – spasms of the bronchi, dilates blood vessels, prevent blood clots. With LH on the background of congenital heart disease systemic diseases and HIV infection this group of products gives a good therapeutic effect.
- Calcium antagonists.
- Antagonists of endothelin receptors.
In addition, spend inhalations with the use of nitric oxide that helps to facilitate blood flow. In this hypertension of the pulmonary artery is reduced, an increased resistance of the patient to physical activity.
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If traditional treatments do not help, hold balloon atrial septostomy. This surgical manipulation, which involves the insertion of a catheter with a blade in the heart, through which an incision of the septum between the Atria with subsequent expansion of the hole. If necessary, in specialized centers may also be done lung transplantation.
Idiopathic forms of the disease, signs of decompensation in the cardio-vascular system, which is constantly increasing, and when the pulmonary artery pressure more than 50 mm of mercury.St. the prognosis is unfavorable. If the speed of the development of signs of LH minor, and the prescribed treatment reduces pulmonary pressure and improves the General condition of the patient, the mortality of patients recorded much less frequently. The end of the disease depends on its form and availability of background pathologies.