Is moderate pulmonary hypertension serious?

Written by Tang Li
Cardiology
Updated on September 12, 2024
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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.

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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.

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Is pulmonary hypertension serious?

Whether pulmonary arterial hypertension (PAH) is serious depends on the cause and the severity of the PAH. It is generally categorized into mild, moderate, and severe. If the PAH is caused by diseases such as pulmonary embolism and is severe, this condition is very serious and may lead to sudden death. If it is chronic pulmonary arterial hypertension with also a severe degree and lasts for a long time, it can lead to right heart failure, and subsequently right heart failure may cause left heart failure, which is also a very serious issue. If the pulmonary hypertension is a reversible, mild condition, such as due to embolism in the pulmonary artery branches which resolves after the embolism is cleared, then the PAH can easily recover, and in this case, it is not serious. However, if it is caused by chronic lung diseases such as chronic obstructive pulmonary disease or pulmonary interstitial fibrosis leading to chronic pulmonary hypertension, it is quite serious because it is a progressively worsening disease. The pulmonary artery pressure will not decrease, and over time it will gradually worsen, eventually leading to heart failure.

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How dangerous is pulmonary hypertension?

Pulmonary hypertension is itself a very complex disease, with many causative factors in clinical practice. In the early stages, patients may only exhibit symptoms such as shortness of breath after activity, difficulty breathing, and overall fatigue. However, as the condition gradually worsens, patients may experience chest tightness, rapid breathing, and even chest pain, fainting, or dizziness. If the patient also has right heart dysfunction, they may experience symptoms like swelling of the lower limbs, as well as diarrhea and abdominal distension. Therefore, if pulmonary hypertension patients are definitively diagnosed and do not receive timely appropriate treatment, the accompanying clinical symptoms may rapidly worsen. The patient's life may be at risk due to severe symptoms such as hypoxia or fainting.

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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.

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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.