What are the most important causes of pulmonary hypertension. Pulmonary hypertension. How to treat in adults

– a threatening pathological condition caused by a persistent increase in blood pressure in the vascular bed of the pulmonary artery. The increase in pulmonary hypertension is gradual, progressive and ultimately causes the development of right ventricular heart failure, leading to the death of the patient. Most often, pulmonary hypertension occurs in young women 30-40 years old, who suffer from this disease 4 times more often than men. The asymptomatic course of compensated pulmonary hypertension leads to the fact that it is often diagnosed only in severe stages, when patients experience heart rhythm disturbances, hypertensive crises, hemoptysis, and attacks of pulmonary edema. In the treatment of pulmonary hypertension, vasodilators, antiplatelet agents, anticoagulants, oxygen inhalations, and diuretics are used.

ICD-10

I27.0 I27.2

General information

– a threatening pathological condition caused by a persistent increase in blood pressure in the vascular bed of the pulmonary artery. The increase in pulmonary hypertension is gradual, progressive and ultimately causes the development of right ventricular heart failure, leading to the death of the patient. The criteria for diagnosing pulmonary hypertension are indicators of mean pressure in the pulmonary artery over 25 mmHg. Art. at rest (with a norm of 9–16 mm Hg) and over 50 mm Hg. Art. under load. Most often, pulmonary hypertension occurs in young women 30-40 years old, who suffer from this disease 4 times more often than men. There are primary pulmonary hypertension (as an independent disease) and secondary (as a complicated variant of the course of respiratory and circulatory diseases).

Causes

The reliable causes of the development of pulmonary hypertension have not been determined. Primary pulmonary hypertension is a rare disease of unknown etiology. It is assumed that factors such as autoimmune diseases (systemic lupus erythematosus, scleroderma, rheumatoid arthritis), family history, and use of oral contraception are related to its occurrence.

Many diseases and defects of the heart, blood vessels and lungs can play a role in the development of secondary pulmonary hypertension. Most often, secondary pulmonary hypertension is a consequence of congestive heart failure, mitral stenosis, atrial septal defect, chronic obstructive pulmonary diseases, thrombosis of the pulmonary veins and branches of the pulmonary artery, pulmonary hypoventilation, coronary artery disease, myocarditis, cirrhosis of the liver, etc. It is believed that the risk of developing pulmonary hypertension higher in HIV-infected patients, drug addicts, and people taking appetite suppressants. In different ways, each of these conditions can cause increased blood pressure in the pulmonary artery.

Pathogenesis

The development of pulmonary hypertension is preceded by a gradual narrowing of the lumen of small and medium-sized vascular branches of the pulmonary artery system (capillaries, arterioles) due to thickening of the inner choroid - the endothelium. With severe damage to the pulmonary artery, inflammatory destruction of the muscular layer of the vascular wall is possible. Damage to the walls of blood vessels leads to the development of chronic thrombosis and vascular obliteration.

The listed changes in the vascular bed of the pulmonary artery cause a progressive increase in intravascular pressure, i.e. pulmonary hypertension. Constantly increased blood pressure in the pulmonary artery increases the load on the right ventricle, causing hypertrophy of its walls. The progression of pulmonary hypertension leads to a decrease in the contractility of the right ventricle and its decompensation - right ventricular heart failure (cor pulmonale) develops.

Classification

To determine the severity of pulmonary hypertension, there are 4 classes of patients with cardiopulmonary insufficiency.

• Class I – patients with pulmonary hypertension without impairment of physical activity. Normal exercise does not cause dizziness, shortness of breath, chest pain, or weakness.
• Class II – patients with pulmonary hypertension causing minor impairment of physical activity. A state of rest does not cause discomfort, however, habitual physical activity is accompanied by dizziness, shortness of breath, chest pain, and weakness.
• Class III – patients with pulmonary hypertension causing significant impairment of physical activity. Minor physical activity is accompanied by dizziness, shortness of breath, chest pain, and weakness.
• Class IV - patients with pulmonary hypertension, accompanied by severe dizziness, shortness of breath, chest pain, weakness with minimal exertion and even at rest.

Symptoms of pulmonary hypertension

In the compensation stage, pulmonary hypertension can be asymptomatic, so the disease is often diagnosed in severe forms. The initial manifestations of pulmonary hypertension are observed when the pressure in the pulmonary artery system increases by 2 or more times compared to the physiological norm.

With the development of pulmonary hypertension, unexplained shortness of breath, weight loss, fatigue during physical activity, palpitations, cough, and hoarseness appear. Relatively early in the clinical picture of pulmonary hypertension, dizziness and fainting may occur due to cardiac arrhythmias or the development of acute cerebral hypoxia. Later manifestations of pulmonary hypertension include hemoptysis, chest pain, swelling of the legs and feet, and pain in the liver.

The low specificity of the symptoms of pulmonary hypertension does not allow a diagnosis to be made based on subjective complaints. The most common complication of pulmonary hypertension is right ventricular heart failure, accompanied by a rhythm disturbance - atrial fibrillation. In severe stages of pulmonary hypertension, thrombosis of pulmonary arterioles develops.

Complications

Diagnostics

Typically, patients who are unaware of their disease consult a doctor with complaints of shortness of breath. When examining the patient, cyanosis is revealed, and with long-term pulmonary hypertension - deformation of the distal phalanges of the fingers in the form of “drum sticks”, and the nails in the form of “hour glasses”. During auscultation of the heart, the accent of the second tone and its splitting in the projection of the pulmonary artery are determined; with percussion, the expansion of the boundaries of the pulmonary artery is determined.

Diagnosis of pulmonary hypertension requires the joint participation of a cardiologist and pulmonologist. To recognize pulmonary hypertension, it is necessary to carry out a whole diagnostic complex, including:

• ECG - to detect hypertrophy of the right heart.
• Echocardiography - to examine the vessels and cavities of the heart, determine the speed of blood flow in the pulmonary artery system.
• Computed tomography - layered images of the chest organs show enlarged pulmonary arteries, as well as heart and lung diseases associated with pulmonary hypertension.
• X-ray of the lungs - determines the bulging of the main trunk of the pulmonary artery, the expansion of its main branches and the narrowing of smaller vessels, and allows indirect confirmation of the presence of pulmonary hypertension when identifying other diseases of the lungs and heart.
• Catheterization of the pulmonary artery and right heart is carried out to determine the blood pressure in the pulmonary artery. It is the most reliable method for diagnosing pulmonary hypertension. Through a puncture in the jugular vein, the probe is brought to the right side of the heart and the blood pressure in the right ventricle and pulmonary arteries is determined using a pressure monitor on the probe. Cardiac catheterization is a minimally invasive technique with virtually no risk of complications.
• Pulmonary angiography is an X-ray contrast study of pulmonary vessels to determine the vascular pattern in the pulmonary artery system and vascular blood flow. It is carried out in a specially equipped X-ray operating room with precautions taken, since the introduction of a contrast agent can provoke a pulmonary hypertensive crisis.

Treatment of pulmonary hypertension

The main goals in the treatment of pulmonary hypertension are to eliminate its cause, lower blood pressure in the pulmonary artery, and prevent blood clots in the pulmonary vessels. The complex of treatment for patients with pulmonary hypertension includes:

1. Taking vasodilating agents that relax the smooth muscle layer of blood vessels (prazosin, hydralazine, nifedipine). Vasodilators are effective in the early stages of the development of pulmonary hypertension before the occurrence of pronounced changes in arterioles, their occlusions and obliterations. In this regard, early diagnosis of the disease and establishment of the etiology of pulmonary hypertension becomes important.
2. Taking antiplatelet agents and indirect anticoagulants that reduce blood viscosity (acetyl salicylic acid, dipyridamole, etc.). In case of severe thickening of the blood, bloodletting is resorted to. In patients with pulmonary hypertension, a blood hemoglobin level of up to 170 g/l is considered optimal.
3. Oxygen inhalation as symptomatic therapy for severe shortness of breath and hypoxia.
4. Taking diuretics for pulmonary hypertension complicated by right ventricular failure.
5. Heart and lung transplantation in extremely severe cases of pulmonary hypertension. The experience of such operations is still small, but it indicates the effectiveness of this technique.

Prognosis and prevention

The further prognosis for already developed pulmonary hypertension depends on its underlying cause and the level of blood pressure in the pulmonary artery. With a good response to therapy, the prognosis is more favorable. The higher and more stable the pressure level in the pulmonary artery system, the worse the prognosis. With severe symptoms of decompensation and a pressure level in the pulmonary artery of more than 50 mm Hg. a significant proportion of patients die within the next 5 years. Prognostically, primary pulmonary hypertension is extremely unfavorable.

Preventive measures are aimed at early detection and active treatment of pathologies leading to pulmonary hypertension.

In medical practice, a condition called pulmonary hypertension occurs. This pathology should not be confused with hypertension. In the latter case, a persistent increase in pressure is not associated with somatic pathology and requires lifelong medication.

Increased pressure in the pulmonary artery system

Any cardiologist knows what pulmonary hypertension is. The human circulatory system is very complex. There are 2 circles: large and small. The first begins from the left ventricle with the aorta and ends with the right atrium. The systemic circulation covers all organs except the lungs. 2 arteries depart from the heart and supply the lung tissue.

They are part of the pulmonary circulation, which starts from the right ventricle and ends at the left atrium. Pulmonary hypertension is a pathological condition in which the pressure in the vessels supplying blood to the alveoli increases. This condition threatens the life of the sick person, as it gradually leads to overload of the right ventricle and the development of heart failure. This pathology is often detected at later stages. There may be no symptoms for a long time.

What is hypertension?

The classification of pulmonary hypertension is based on etiological factors. It can be primary and secondary. There is a hereditary predisposition to this pathology. If there are no abnormalities in the lungs, heart, pleura and chest organs, then such hypertension is called primary. It is detected much less frequently. A secondary form of hypertension develops more often.

It comes in the following types:

• toxic;
• associated with respiratory tract pathology or associated with a lack of oxygen;
• cardiac;
• early (detected in newborns);
• thromboembolic;
• unknown etiology.

Pulmonary hypertension is classified by degree (class). There are only 4 of them. Class 1 hypertension occurs most easily. It is characterized by increased blood pressure and normal physical activity. Daily activities do not cause symptoms. In patients of class 2, complaints are absent at rest, but occur during moderate physical activity.

Shortness of breath, weakness and dizziness may occur. A pronounced impairment of activity is observed in class 3 hypertension. For such people, even minor work causes symptoms. For pulmonary hypertension, the classification identifies class 4. It is the most difficult. Stage 4 hypertension is characterized by the appearance of complaints even at rest.

Why does blood pressure rise?

The following causes of pulmonary hypertension are distinguished:

• chronic pathology of the respiratory system;
• heart and vascular diseases;
• thrombosis and thromboembolism of the pulmonary artery;
• hypoxia;
• poisoning with drugs or toxic compounds;
• blood diseases;
• HIV infection;
• increased pressure in the portal vein system;
• liver failure;
• hyperthyroidism;
• hereditary and autoimmune diseases;
• tumors;
• chest injuries;
• deformation of the spine and chest.

Most often, hypertension is caused by pathology of the respiratory system. These may be chronic obstructive disease, bronchitis, bronchiectasis, congenital malformations of lung tissue, fibrosis, asthma. Slightly less often, heart and vascular diseases lead to hypertension. The cause may be a narrowing of the mitral valve, congenital anomalies (atrial septal defect), or congestive heart failure.

Often the pressure in the pulmonary artery system increases against the background of coronary heart disease (angina pectoris and myocardial infarction), valve prolapse, and myocarditis. The cause may be a decrease in the lumen of the vessel due to thrombosis or embolism. Less commonly, the pulmonary form of hypertension is associated with sarcoidosis, mediastinitis, and tumors.

High pressure in the pulmonary artery system is possible due to hypertension. The following predisposing factors for the development of this pathology are identified:

• smoking;
• contact with allergens and toxins;
• uncontrolled use of medications;
• alcoholism;
• stress;
• unfavorable environment;
• obesity;
• physical inactivity;
• overwork;
• presence in the family of patients with pulmonary hypertension;
• oxygen starvation;
• climbing to great heights;
• the presence of atherosclerosis;
• diabetes;
• frequent colds;
• self-medication.

A risk factor is young age (30 to 40 years). Women get sick 4 times more often than men. It is not always possible to identify the causes of a persistent increase in blood pressure in the lungs. This type of hypertension is idiopathic. In young children, this pathology is associated with frequent pneumonia, bronchiolitis and asthma.

General clinical manifestations

Symptoms of pulmonary hypertension are determined by the following factors:

• stage;
• the age of the person;
• concomitant pathology;
• reason.

At an early stage, the clinical picture is blurred. There may be no symptoms for years. The most commonly observed signs of pulmonary hypertension are:

• increased fatigue;
• dyspnea;
• weakness;
• rapid heartbeat;
• squeezing pain in the chest area;
• dizziness;
• swelling;
• dry cough;
• fainting.

Symptoms appear only when the pressure in the pulmonary arteries is 2 times higher than normal. Complaints arise when blood pressure rises to 25 mmHg. and more. Shortness of breath is caused by impaired pulmonary ventilation and hypoxia. It appears at any time, but most often during physical activity.

With venous hypertension, this occurs at night or while the person is lying down. A manifestation of hypoxia (oxygen starvation) in heart failure against a background of high blood pressure is tachycardia. The heart rate in patients exceeds 80 beats per minute. Early symptoms of hypertension include dizziness and fainting. Patients often experience abnormal heart rhythm.

The initial stage of pulmonary hypertension is characterized by decreased performance and loss of body weight. Many patients experience chest pain similar to angina pectoris.

It is compressive and occurs mainly during active movements. If treatment is not started on time, the patient’s condition worsens. The following symptoms appear:

• swelling;
• pain in the liver area;
• cyanosis;
• interruptions in heart function;
• nausea;
• vomit;
• abdominal pain;
• increased gas formation;
• neurological symptoms.

Against the background of brain hypoxia, a headache appears. In the later stages of pulmonary hypertension, right ventricular failure develops. This leads to stagnation of blood in the systemic circle and the appearance of edema. They occur predominantly on the legs. Periodic hemoptysis indicates a person’s serious condition. An enlarged liver is often detected, which is manifested by bursting pain in the right hypochondrium. A person is bothered by a constant cough, severe shortness of breath at rest and hoarseness of the voice.

Possible consequences and complications

Severe pulmonary hypertension, if left untreated, often leads to negative consequences. The following complications may develop:

• right ventricular failure;
• atrial fibrillation;
• thrombosis;
• hypertensive crises;
• pulmonary edema;
• pulmonary embolism;
• rhythm disturbances in the form of atrial flutter.

The most common complication is chronic heart failure, which is caused by blood stagnation and overload of the right ventricle. As a result, the contractile function of the myocardium is impaired. Right ventricular failure is manifested by swelling of the legs, pain in the hypochondrium on the right, pulsation of the veins in the neck and their swelling, weak and rapid pulse, decreased blood pressure, increased central venous pressure, shortness of breath, pressing pain in the heart.

All this worsens the condition of patients. A very common complication is hypertensive crises. In their course they resemble pulmonary edema. A dangerous complication is thrombosis. It can cause blockage of the pulmonary artery. Often this condition leads to death.

How to detect hypertension

With pulmonary hypertension, symptoms are not specific. It is impossible to make a diagnosis based on the clinical picture alone.

To identify this pathology, the following studies are required:

• electrocardiography;
• Ultrasound of the heart and large vessels;
• CT scan;
• catheterization;
• radiography of pulmonary vessels using a contrast agent;
• X-ray examination of the chest organs;
• spirometry;
• Ultrasound of the liver and kidneys;
• assessment of blood gas status;
• general and biochemical tests.

Additionally, a walking test is performed. The duration of the load is 6 minutes, after which the patient’s condition is assessed. The results of blood clotting tests are of no small importance. This allows you to assess risk factors for blood clots. Before treating patients, it is imperative to conduct an electrocardiogram.

During this study, overload of the right ventricle and right atrium is revealed. The most reliable way to detect hypertension is to measure the pressure in the pulmonary vessels. This is possible during catheterization. The degree of hypoxia is assessed during blood gas analysis. The results of anamnesis and physical examination play a major role in making a diagnosis.

Treatment methods for hypertension

Not everyone knows how to treat pulmonary hypertension. Therapy is aimed at eliminating the main etiological factor and reducing blood pressure.

For pulmonary hypertension, treatment involves the use of drugs that dilate blood vessels, antiplatelet agents, anticoagulants, inhalations, diuretics, nitrates, and antibiotics.

Doctors' recommendations must be followed in full. Calcium antagonists are indicated to reduce heart rate, relax the bronchi and dilate blood vessels. This group includes Nifedipine. It also has a hypotensive effect. Calcium antagonists are very effective in treating hypoxia, as they reduce the heart's need for oxygen.

Treatment for pulmonary hypertension often includes taking nitrates (Nitroglycerin). They reduce the load on the heart muscle. Antihypertensive drugs from the ACE group (Captopril, Enalapril, Prestarium) are required. To prevent the formation of blood clots, antiplatelet agents and anticoagulants are required. These include Aspirin and Dipyridamole.

In severe cases, drugs from the group of endothelin receptor antagonists may be prescribed. If hypertension has developed against the background of bronchitis or asthma, then medications that dilate the bronchi and improve air exchange (Eufillin, Salbutamol) are indicated. If a bronchopulmonary infection is detected, a course of antibiotic therapy is administered.

Medicines are administered by injection. Nitric oxide has a vasodilating effect. This substance is administered through inhalation. In case of development of right ventricular failure and the appearance of edema syndrome, diuretics (Lasix) are included in the treatment regimen. In parallel with drug therapy, non-drug therapy is carried out.

All patients should reduce the amount of salt and fluid they consume. Oxygen therapy is required to enrich the blood with oxygen and improve the function of the heart and brain. Physical activity should be dosed. You can't overexert yourself. People with hypertension are not recommended to climb to greater heights from the ground, as the pressure there is higher.

Surgical treatment and prognosis

A slight increase in pressure in the pulmonary artery system does not require radical therapeutic measures. The operation is performed in the late stages of hypertension and the ineffectiveness of conservative treatment. The most commonly performed types of surgery are:

• lung transplant;
• removal of blood clots;
• septostomy (formation of an opening between the atria).

Organ transplantation (lungs or heart) is performed only in advanced cases. In pulmonary hypertension, the prognosis is determined by the degree of pressure rise, the duration of the disease and the timeliness of treatment. The reasons are important. With persistent pressure in the pulmonary arteries above 50 mm Hg. and symptoms of heart failure, the prognosis is favorable. The most dangerous is the primary form of hypertension. Thus, high pressure in the pulmonary vascular system poses a danger to human life.

Video

Pulmonary hypertension (PH) is a disease in which the pressure in the pulmonary artery increases. Normally, systolic pressure in the pulmonary circulation should be 18-25 mm Hg, diastolic pressure should be 6-10 mm Hg, and the average specific pressure should be within 12-16 mm Hg. The diagnosis of pulmonary hypertension is made if the average specific pressure exceeds 30 mmHg. during physical activity and 25 mm Hg. at rest.

This disease significantly worsens the patient's condition and has a poor prognosis.. In some cases, it develops slowly, so patients may not realize they have pulmonary hypertension for a long time and begin treatment at a late stage. But remember that in any case, not all is lost: if you have been diagnosed with this disease, you can improve your condition thanks to special folk remedies. They reduce pressure in the pulmonary artery and relieve unpleasant symptoms.

Pulmonary hypertension is a dangerous disease that requires the patient to take his health very seriously. Timely treatment will help avoid a negative scenario, while unattended pathology can eventually lead to the death of the patient.

What is the disease

Pulmonary hypertension is a condition in which there is a persistent increase in blood pressure in the pulmonary artery.

Increased pressure in the pulmonary arteries leads to enlargement of the right ventricle and, as a consequence, heart failure

The phenomenon of increased pressure in the pulmonary artery can be caused by increased resistance in the bloodstream of the lungs or a sharp increase in the volume of blood passing through the pulmonary circulatory system. This process occurs gradually and, in the end, if the patient is not provided with timely qualified medical care, it can result in death, the immediate cause of which is right ventricular heart failure.

Pulmonary hypertension should not be confused with arterial hypertension, also called hypertension, in which total blood pressure periodically or constantly increases. These pathologies differ in the nature of their occurrence and health risks.

Pulmonary hypertension affects people at the most active age - 30–40 years, and in women the pathology is registered four times more often than in men. The particular danger of the disease is that for a long period of time it can be practically asymptomatic, and therefore, by the time the diagnosis is made, it can sometimes be very difficult, if not impossible, to help the patient.

Classification and forms of pathology

Experts divide pulmonary hypertension into two main types - primary (idiopathic) and secondary.

1. The idiopathic form of the pathology is relatively rare, has an unclear nature and in most cases depends on hereditary factors and autoimmune diseases. Such hypertension can be transmitted not only to the next generation, but also through generations. It is characterized by an increase in the size of the right ventricle and sclerotic transformations of the pulmonary artery and is characterized by narrowing of the pulmonary vessels.
   

   The primary form of pulmonary hypertension is characterized by rapid progression. In most cases, it causes the patient to become unable to work, and sometimes leads to death.

2. The secondary form of pulmonary hypertension is often associated with connective tissue pathologies, for example, scleroderma, congenital and acquired heart defects, and immunodeficiency virus (HIV). In addition, it can result from pulmonary artery and other diseases that cause insufficiency of left ventricular function. Sometimes it develops with lung diseases, but in such cases it does not take severe forms.

Thromboembolic and post-embolic hypertension are also distinguished.

Depending on the pressure parameters in the pulmonary artery, three degrees of hypertension are distinguished:

• I (mild) - 25–45 mm Hg;
• II (moderate) - 45–65 mm Hg;
• III (severe) - over 65 mm Hg.

Reasons for the development of pathology

Pulmonary hypertension can be triggered by a number of factors, including:

Medicinal and chemical substances that can cause the development of pulmonary hypertension - table

Symptoms and signs

The symptomatic picture of pulmonary hypertension depends on the severity of the disease.

Classification of patients depending on the severity (degree) of the disease - table

In the compensated variant, the disease may not be detected for a long time. The first signs appear when the pressure in the pulmonary artery increases twice as much as the accepted norm.

As the disease progresses, the symptomatic picture worsens; shortness of breath and weakness are accompanied by tachycardia, atrial fibrillation, cough, and hoarse voice. Over time, the patient begins to suffer from frequent fainting due to heart failure and oxygen starvation (hypoxia) of the brain.

In severe stages of pulmonary hypertension, the following additionally develop:

• hemoptysis;
• severe pain in the chest;
• swelling of the lower extremities;
• liver dysfunction;
• thrombosis of pulmonary vessels.

Pulmonary hypertension in the later stages is characterized by the presence of attacks - hypertensive crises, during which pulmonary edema may occur with increasing asphyxia. The following symptoms are also present:

• hacking cough with sputum;
• cyanosis (blue discoloration) of the skin;
• psychomotor agitation;
• strong pulsation of the neck veins;
• increased secretion of low-concentrated urine and involuntary defecation after the end of the crisis.

There is a high risk of death due to the development of pulmonary heart failure and possible pulmonary embolism.

Basic diagnostic methods

The first factor that patients pay attention to is shortness of breath, and they rush to see a doctor with complaints about it. Already upon examination of the patient, the specialist identifies symptoms that allow a preliminary conclusion to be made about the presence of pulmonary hypertension. External signs of pathology may be:

• bluish tint to the skin;
• a specific shape of the fingers, the outer phalanges of which are thickened like drumsticks;
• convex nails, shaped like a watch glass.

The diagnosis of pulmonary hypertension usually involves a pulmonologist and a cardiologist, each of whom conducts a number of examinations to make an accurate diagnosis:

How to treat pulmonary hypertension

The main goal of therapy in this case is to eliminate the causes of the disease, combat the formation of blood clots and lower pressure in the pulmonary artery. To achieve this, complex measures are taken, including medications, physiotherapy, and sometimes surgical treatments.

Important! As for treatment using alternative (traditional) medicine methods, this is strictly contraindicated for pulmonary hypertension.

Conservative therapy

1. Patients are recommended to take drugs that relax the smooth muscles of blood vessels (Prazosin, Nifedipine). These measures have a good effect in the early stages of the disease, until the vessels are obliterated.
2. If treatment is necessary, patients may be prescribed Sildenafil, better known as Viagra.
   

   It is curious that Sildenafil (Viagra) was originally invented as a treatment for coronary heart disease. However, as it later turned out, the use of this drug causes an active rush of blood to the pelvic organs. So the side effect exceeded the main effect.

3. If the patient is diagnosed with right heart failure, diuretics are used.
4. To combat thromboembolism, the use of anticoagulants and medications that reduce blood viscosity (Cardioaspirin, Dipyridamole) is indicated.
5. If the blood is too thick, you have to resort to bloodletting.
6. In case of severe shortness of breath and oxygen starvation, the patient is given oxygen therapy - saturating the body with oxygen. The patient is also recommended to have a quiet lifestyle with the exception of any physical activity.

Diet

Proper nutrition, excluding foods high in cholesterol, is an important component of the treatment of pulmonary hypertension.

The following should be excluded from the diet:

• fat meat;
• sweets;
• salty foods;
• caffeine;
• alcoholic drinks, etc.

Can be used:

• vegetables;
• fruits;
• cereals;
• nuts;
• low-fat lactic acid products;
• vegetable oils;
• poultry;
• fish.

Surgical intervention

In severe forms of pulmonary hypertension, surgery cannot be avoided. The types of operations differ significantly depending on the cause that needs to be eliminated.

1. Embolectomy and thromboendarterectomy. If pulmonary hypertension is the result of a blood clot blocking the artery, the patient undergoes an emergency embolectomy, which is the removal of the clot blocking the artery. When arterial thrombosis becomes chronic, a thromboendarterectomy is performed - a thrombus located in the blood canal is excised along its entire length using a longitudinal incision in the artery. This operation is quite complex, but it helps in most cases to restore pulmonary function.

   Contraindications to embolectomy are advanced age coupled with severe concomitant diseases.

2. Balloon atrial septostomy. The surgical operation is aimed at eliminating the consequences of a congenital heart defect, when it becomes necessary to expand the existing defect of the cardiac septum or even artificially create it. Such measures make it possible to optimize the discharge of oxygen-rich blood into the right half of the heart. The surgical technique consists of widening the hole in the heart septum using a special balloon filled with air.
3. Lung and heart-lung complex transplantation. This is a very complex and expensive operation that requires special equipment and the highest qualifications of surgeons, but in some cases only it can save the patient’s life. Such a surgical intervention carries many risks, among which the main one is the likelihood of donor tissue rejection. In addition, it is very difficult to find a suitable donor. Such operations are prescribed in exceptional cases and only for patients with stage IV pathology, when they are practically confined to a bed or wheelchair.

Women diagnosed with pulmonary hypertension are advised to avoid pregnancy. If the pathology has already developed while the child is expecting, an abortion is performed for medical reasons to save the patient’s life, after which adequate treatment is prescribed.

Babies born with pulmonary hypertension need resuscitation measures - they are given oxygen therapy to stop the progression of the disease. Oxygen saturation is carried out both through ventilation of the lungs and at the cellular level. At the same time, the newborn is cultured to check for infection and treated with antibacterial drugs until the results are obtained.

Prognosis and complications

The prognosis for the course of pulmonary hypertension will depend on the reason for which the pathology developed. If treatment is started in a timely manner, the outcome will be more favorable.

Medical statistics show that the average survival rate of patients with pulmonary hypertension who have not received treatment does not exceed 2.5 years. With drug therapy, the survival rate over five years is 53–55%, and with a positive reaction of the body to the drugs, it reaches 90%.

The disease has an unfavorable prognosis with a significant increase in pressure in the pulmonary artery - more than 50–55 mm Hg. Art. Within a few years, such patients die.

Prevention measures

Prevention of pulmonary hypertension consists of timely identification of the causes that cause the disease, making an accurate diagnosis and effective treatment.

It will not be superfluous to follow nutritional rules in which:

• reduced amount of salt;
• the daily volume of liquid consumed is limited to 1.5 liters;
• the diet contains sufficient quantities of vitamins and microelements - especially magnesium and potassium;
• High cholesterol foods are excluded from the menu.

Fans of mountaineering who have prerequisites for the development of pathology should give up their hobby.

Elena Malysheva about pulmonary hypertension in adults and children - video

Pulmonary hypertension is an extremely serious disease, which, fortunately, is quite rare, but this should not lull vigilance against this dangerous pathology. The appearance of the first symptoms is a reason to contact a specialist.

In this article you will learn: what is pulmonary hypertension. The causes of the development of the disease, types of increased pressure in the vessels of the lung, and how the pathology manifests itself. Features of diagnosis, treatment and prognosis.

Article publication date: 07/01/2017

Article updated date: 05/29/2019

Pulmonary hypertension is a pathological condition in which there is a gradual increase in pressure in the pulmonary vascular system, which leads to increasing insufficiency of the right ventricle and ultimately ends in the premature death of a person.

When the disease occurs in the circulatory system of the lungs, the following pathological changes occur:

In order for blood to pass through the changed vessels, the pressure in the trunk of the pulmonary artery increases. This leads to increased pressure in the cavity of the right ventricle and leads to disruption of its function.

Such changes in blood flow manifest themselves as increasing respiratory failure in the early stages and severe heart failure in the final stages of the disease. From the very beginning, the inability to breathe normally imposes significant restrictions on the patients’ daily life, forcing them to limit themselves in exercise. The decrease in resistance to physical labor worsens as the disease progresses.

Pulmonary hypertension is considered a very serious disease - without treatment, patients live less than 2 years, and most of this time they require help with personal care (cooking, cleaning the room, shopping for groceries, etc.). With therapy, the prognosis improves somewhat, but the disease cannot be completely cured.

The problem of diagnosing, treating and monitoring people with pulmonary hypertension is dealt with by doctors of many specialties, depending on the cause of the disease, these can be: therapists, pulmonologists, cardiologists, infectious disease specialists and geneticists. If surgical correction is necessary, vascular and thoracic surgeons are involved.

Classification of pathology

Pulmonary hypertension is a primary, independent disease in only 6 cases per 1 million population; this form includes the causeless and hereditary form of the disease. In other cases, changes in the vascular bed of the lungs are associated with any primary pathology of an organ or organ system.

On this basis, a clinical classification of increased pressure in the pulmonary artery system was created:

An increase in pressure in the circulatory system of the lungs due to a violation of the structure of the heart is noted with defects associated with the discharge of arterial blood into the venous system: defects in the septa between the atria and ventricles, open ductus arteriosus.

Causes and risk factors for development

The following reasons may influence the increase in pressure in the pulmonary arteries:

Manifestations of pathology, classes of disease

The primary stage of changes in the vascular system of the lungs proceeds unnoticed - compensatory, replacement mechanisms cope with the emerging pathology, and this is enough for the patient’s normal condition.

When the level of average pressure in the pulmonary artery reaches a critical level of 25–30 mm Hg. Art. The first symptoms of pulmonary hypertension appear. At this stage, the patient experiences deterioration only during physical overexertion and lives a full life.

As changes in the blood vessels progress, tolerance to stress decreases; as a result, even household chores may require outside help.

In order to assess the severity of the disease, depending on the severity of manifestations, pulmonary hypertension is divided into classes.

Diagnostics

Having decided what kind of disease pulmonary hypertension is, how it manifests itself and why it occurs, we can move on to the specifics of making a diagnosis. The table presents methods for examining the patient and pathological changes characteristic specifically of increased pressure in the circulatory system of the lungs. Signs of the disease that caused the pathology (if any) are not indicated in this article.

Additional research methods

Used to clarify the cause of increased pressure in the pulmonary artery system and to carry out clarifying diagnostics if there is no certainty about the exact disease. These studies are also necessary to establish the clinical class of pulmonary hypertension.

1. FVD (function of external respiration). It is necessary to evaluate to exclude pathology of the respiratory system. With increased pressure in the circulatory system of the lungs, a moderate decrease in the partial pressure of oxygen and carbon monoxide (the main blood gases) is noted.
2. Ventilation-perfusion lung scintigraphy is a study of the lungs by introducing radioactive particles into the blood. It is carried out to exclude blockage of the branching arteries of the lungs by clots, as the main cause of breathing problems.
3. MSCT (multispiral computed tomography) of the heart and lungs with contrast enhancement is an x-ray method of creating a three-dimensional image of an organ using a computer program. It allows you to accurately determine the cause of the increase in pressure, if it is associated with the cardiovascular or respiratory systems, as well as assess the degree of dysfunction of the heart muscle and the level of replacement of the pulmonary vessels with connective tissue.
4. APG (angiopulmonography) - injection of a contrast agent into the vessels of the lungs and recording of the resulting image using x-rays. Indicated for suspected thromboembolism, which could not be detected by other studies.

Treatment methods

Any treatment for pulmonary hypertension provides only a temporary effect. It is impossible to completely rid the patient of the disease, regardless of the cause of the increase in pressure in the blood vessels of the lungs. With a good response to treatment, the general condition of the patient improves, the ability to perform physical activity improves, and life expectancy more than doubles. If the pathology is not treated, death occurs within 2 years after detection of the disease.

• avoid physical activity after eating food and under unfavorable temperature conditions (very hot or cold);
• perform daily dosed physical exercises that do not cause symptoms and maintain good vascular tone;
• use oxygen therapy during air travel;
• avoid and prevent inflammatory diseases of the bronchi and lungs;
• do not use hormone replacement therapy during menopause;
• if possible, refrain from pregnancy and childbirth;
• do not use hormonal methods of birth control;
• prevent a decrease in hemoglobin levels (anemia).

Medicines

Drug therapy is the main method of correcting pulmonary hypertension. Several groups of drugs are used in treatment, most often in combination with each other.

1. Basic treatment - the patient receives the medicine on an ongoing basis

2. Course treatment - used several times a year or as needed

Oxygen therapy is a highly effective way to increase blood saturation levels when the condition worsens or in unfavorable environmental conditions.

Nitric oxide - has a high vasodilating effect, is used for inhalation for several hours only when hospitalized in a hospital.

Surgical methods of treatment

Used in cases of low effectiveness of drug treatment and in cases of malformations of the heart muscle.

Forecast

Once a diagnosis of pulmonary hypertension is made, the prognosis for complete recovery is poor. The life span of patients, even with treatment, is limited. In any form of the disease, there is a rapid or slow increase in the insufficiency of the right half of the heart muscle, which causes the death of the patient.

• The most unfavorable course is pulmonary hypertension against the background of systemic scleroderma (degeneration of organ cells into connective tissue) - patients live no more than a year.
• The prognosis for the primary form of increased pressure in the blood vessels of the lungs is slightly better: the average lifespan is up to 3 years.
• The development of cardiac and pulmonary failure due to cardiac malformations is an indication for surgical treatment (organ transplantation). 40–44% of such patients survive the five-year period.
• An extremely unfavorable factor is the rapid increase in insufficiency of right ventricular function and its extreme forms of manifestation. Treatment in such cases has no effect, and patients die within 2 years.
• With a good response to drug treatment (with a “mild” form of pulmonary hypertension), more than 67% of patients survive the five-year period.