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Pulmonary Hypertension
Is moderate pulmonary hypertension serious?
Pulmonary hypertension is a common clinical condition with complex etiology, which can be caused by various cardiac, pulmonary, or pulmonary vascular diseases. The current diagnostic criteria for pulmonary hypertension are an average pulmonary arterial pressure greater than 25 mmHg at sea level in a resting state, or greater than 30 mmHg during exercise, as measured via right heart catheterization. The severity of pulmonary hypertension can be categorized based on resting average pulmonary arterial pressure levels into mild (26 to 35 mmHg), moderate (36 to 45 mmHg), and severe (greater than 45 mmHg). Echocardiography is the most important non-invasive screening method for pulmonary hypertension. Assessing the severity of moderate pulmonary hypertension not only involves the measurement of average pulmonary arterial pressure but also necessitates identifying its etiology. Since pulmonary hypertension is a disease with a complex etiology, it is crucial to first clarify the cause, and then further determine the patient's cardiopulmonary function status, whether it is in a compensatory or decompensatory stage. Additionally, it is important to determine if there are any related complications, such as pulmonary hypertension stemming from lung-induced conditions. When patients exhibit complications like pulmonary encephalopathy, acid-base imbalance, electrolyte disturbances, arrhythmias, or even shock and gastrointestinal bleeding, the severity of pulmonary hypertension can be extremely severe.
How is pulmonary hypertension measured?
There are usually two methods to measure pulmonary arterial hypertension. One is through echocardiography to estimate, by measuring the speed of tricuspid regurgitation and then calculating the systolic pressure of the pulmonary artery through a formula. This method may overestimate or underestimate, hence its accuracy is not reliable. The gold standard is measuring pulmonary artery pressure via right heart catheterization. The downside of this gold standard is that it is an invasive procedure, which needs to be performed in a catheterization room; compared to ultrasound, it is also more costly. These are the two methods, each with its pros and cons. We need to choose based on the patient's situation.
How is pulmonary hypertension treated?
The treatment of pulmonary hypertension mainly focuses on identifying the cause. For idiopathic pulmonary hypertension, treatment primarily targets vascular constriction, endothelial damage, thrombus formation, and heart failure. This is to restore the tension, resistance, and pressure of the pulmonary vessels, improve the patient's sexual function, increase cardiac output, and improve quality of life. The main treatments include: 1. Drug therapy, which includes calcium channel blockers, prostacyclin, nitric oxide, endothelin receptor antagonists, and related anticoagulants. Anticoagulants do not improve symptoms, but can slow down disease progression and improve prognosis in some aspects. However, in cases of right heart failure, hepatic congestion, and ascites, cardiotonic diuretics are used, such as digoxin and anti-calcium channel blockers, which can cause adverse reactions like decreased myocardial contractility. But these drugs should be administered under the guidance of a doctor. In advanced stages of pulmonary arterial hypertension, heart-lung transplantation may be considered.
Pulmonary hypertension belongs to which department?
Pulmonary hypertension is a relatively complex disease with many types, and the department to which a patient should go depends on the type. For example, patients with idiopathic pulmonary hypertension often need to visit the department of cardiology. Similarly, pulmonary hypertension associated with left heart disease also falls under the jurisdiction of cardiology. However, if the pulmonary hypertension is related to hypoxia, these patients typically belong to the department of respiratory medicine. Furthermore, there are cases of chronic thromboembolic pulmonary hypertension, where patients can be seen either in cardiology or respiratory medicine. Therefore, answering which department pulmonary hypertension belongs to is a complex issue that requires classification based on the cause of the disease.
What happens to pulmonary hypertension if you stay up late?
Because if pulmonary hypertension is not treated consistently, it can further develop into pulmonary heart disease, which is very dangerous. Patients may also experience palpitations, chest tightness, and difficulty breathing, especially after respiratory activities, where palpitations and breathing difficulties worsen. Frequent staying up late can lead to abnormal arterial hypertension in patients and cause this high pressure to continue to rise. Sometimes the condition can worsen because once patients are diagnosed with pulmonary hypertension, it is important to rest, especially to avoid staying up late, as it can cause further worsening due to vascular constriction.
The harms of pulmonary arterial hypertension during pregnancy
Pulmonary hypertension is categorized into mild, moderate, and severe stages. If it is mild pulmonary hypertension, pregnancy generally does not have a major impact. However, for those with moderate or especially severe pulmonary hypertension, pregnancy can be very dangerous for both the mother and the fetus. As the fetus grows, pulmonary hypertension can lead to ischemia and hypoxia, which can worsen over time. The mother is likely to develop symptoms of acute heart failure, severely endangering her life. Additionally, it can cause intrauterine hypoxia for the fetus, leading to miscarriage or stillbirth. Therefore, pregnancy is not recommended for patients with moderate, and particularly severe, pulmonary hypertension.
Can pulmonary hypertension cause coughing?
Pulmonary arterial hypertension is a commonly seen clinical condition with complex causes, which may arise from various cardiac, pulmonary, and pulmonary vascular diseases. When pulmonary arterial hypertension occurs, due to increased resistance in the pulmonary circulation, the load on the right heart will increase, eventually leading to right heart failure, thus causing a series of clinical manifestations. In the early stages, pulmonary arterial hypertension may not present with obvious symptoms, and discomfort may be felt during intense exercise, with most patients showing shortness of breath after activity. During the compensatory period of pulmonary heart function, symptoms such as palpitations, shortness of breath, fatigue, and decreased endurance may occur during activities, and acute infections can also exacerbate these conditions, potentially causing mild chest pain or hemoptysis. Some patients may exhibit signs of heart dysfunction, like coughing and expectorating phlegm.
How to treat pulmonary hypertension?
Pulmonary arterial hypertension (PAH), depending on its various causes, has different treatments. The treatment commonly referred to as for pulmonary arterial hypertension specifically targets Group 1 PAH. This category of PAH has some targeted medications that are quite effective, such as prostacyclin medications, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. These drugs target pulmonary artery pressure among other things. In addition to targeted treatments, anticoagulant therapy is usually necessary. When right heart failure occurs, diuretic therapy may be needed. In advanced stages, heart-lung or lung transplantation might be required.
Obvious symptoms of pulmonary hypertension
Pulmonary hypertension is a relatively common disease in everyday life. Based on the causes of pulmonary hypertension, it can be divided into two categories: primary and secondary pulmonary hypertension. Regardless of the type of pulmonary hypertension, patients often exhibit certain symptoms, such as chest tightness and shortness of breath, which are the most common symptoms. In severe cases, some patients may even experience syncope. When pulmonary hypertension affects the heart, causing right ventricular enlargement, patients often show signs of right heart failure, such as shortness of breath, difficulty breathing, lower limb edema, and gastrointestinal symptoms, such as nausea and abdominal distension.