Pulmonary arterial hypertension standards

Written by Tang Li
Cardiology
Updated on September 28, 2024
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Pulmonary hypertension is a common clinical condition with very complex causes, which can be induced by a variety of heart, lung, and pulmonary vascular diseases. When pulmonary hypertension occurs, because the resistance in the pulmonary circulation increases, the burden on the right heart increases, eventually leading to right heart failure, thus causing a series of clinical manifestations. During the disease course, pulmonary hypertension commonly shows progressive development. Currently, the diagnostic criteria for pulmonary hypertension are an average pulmonary artery pressure greater than 25 mmHg measured by right heart catheterization at sea level in a resting state, or greater than 30 mmHg during exercise. Additionally, diagnosing arteriogenic pulmonary hypertension requires, beyond the aforementioned criteria, that the pulmonary capillary wedge pressure or left ventricular end-diastolic pressure be less than 15 mmHg. The severity of pulmonary hypertension can be classified into mild, moderate, and severe stages based on resting mean pulmonary artery pressure levels. Mild is defined as 26 to 35 mmHg, moderate as 36 to 45 mmHg, and severe as greater than 45 mmHg. Echocardiography is the most important non-invasive examination method for assessing pulmonary hypertension, and it is recommended that a pulmonary artery systolic pressure greater than 40 mmHg be considered indicative of pulmonary hypertension according to echocardiographic standards.

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Symptoms of pulmonary hypertension

The symptoms of pulmonary arterial hypertension are varied. In the early stages when pulmonary cardiac function is compensatory, the symptoms mainly include cough, phlegm, shortness of breath, difficulty breathing, and fatigue. Later, when pulmonary cardiac function becomes decompensated, symptoms of respiratory failure and right heart failure may occur. In cases of right heart failure, symptoms mainly manifest as systemic circulatory congestion, including visceral nausea, vomiting, palpitations, and pronounced shortness of breath. In respiratory failure, particularly pulmonary hypertension caused by pulmonary heart disease, symptoms like drowsiness, confusion, and gaze fixation, which are typical of pulmonary encephalopathy, may occur. Therefore, the symptoms of pulmonary arterial hypertension are diverse.

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Early symptoms of pulmonary arterial hypertension

It depends on what disease causes pulmonary hypertension. There are several common causes of pulmonary hypertension, one of which is a pathological change in the pulmonary artery itself. Early on, there may be signs of mild increases in pulmonary artery pressure, possibly accompanied by slight right heart dysfunction. At this stage, symptoms such as mild hypotension and hypoxia might occur, manifesting as dizziness and fatigue. If the pulmonary hypertension is due to a disease of the lungs themselves, such as changes in the lung interstitium, then early symptoms of hypoxia will be more apparent, with chest tightness, slight breathing difficulties, and feelings of suffocation. If pulmonary hypertension is caused by conditions such as pulmonary embolism—specifically, an embolism in a smaller branch—the increase in pulmonary artery pressure may not be significant and will also be mild. This may be accompanied by a slight drop in blood pressure and mild breathing difficulties; however, because it is mild pulmonary hypertension, these symptoms are not severe and might include slight respiratory difficulty, mild chest tightness, shortness of breath, and mild dizziness. Therefore, early symptoms of pulmonary hypertension are typically not pronounced and generally do not attract special attention from patients.

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Can pulmonary hypertension cause headaches?

Pulmonary hypertension is a clinically complex disease with a wide range of causes. Consequently, the symptoms it presents in patients are numerous and complicated. Typically, patients with increasing pulmonary hypertension may experience varying degrees of shortness of breath after activity, chest tightness, dizziness, as well as chest pain, palpitations, and fainting. Generally, it does not cause headaches. However, many cases of pulmonary hypertension might also involve conditions such as hypertension, or other diseases that could lead to headaches. When pulmonary hypertension is worsening, it might coincide with an increase in blood pressure, which could also trigger headaches at that time. Therefore, it is important to differentiate in clinical practice; primary pulmonary hypertension generally does not cause headaches but can cause dizziness.

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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.

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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.