Pulmonary hypertension - is a pathology that is characterized by increased pressure in the pulmonary artery and is accompanied by cardiac arrhythmia, shortness of breath and other serious symptoms. The disease is progressive in nature, but at first it takes virtually no symptoms, making it difficult to diagnosis and treatment selection.
To correct this condition are recommended lifestyle changes, taking of drugs (diuretics,. Anticoagulants, etc.), symptomatic oxygenic inhalation, and in severe cases - surgical intervention.
What causes
Depending on the etiology of occurrence of hypertension may be primary or secondary disease. The initial increase in pressure in the pulmonary artery is a rare disease that develops mostly in adult women 30-40 years of age. This disease is registered in 2-3 cases per 1 million inhabitants.
In studies of the primary causes of pathology deals with the role of autoimmune processes (systemic lupus erythematosus, scleroderma, etc.), family history of complicated, long-term use of hormonal drugs and other factors.
The causes of pulmonary hypertension secondary character are the following states:
- Chronic lung disease. Etiologies include interstitial lung disease, alveolar hypoventilation, obstructive bronchial diseases, acute lung injury and others. Initially mechanism for pulmonary hypertension pathologies for reducing tissue hypoxia, and eventually it difficult for the underlying disease.
- Pulmonary vascular pathology. Thromboembolism pulmonary artery branches provoking lack of oxygen in the heart muscle. The increased pressure in the pulmonary artery blood flow and compensates for the insufficiency cause secondary pulmonary hypertension.
- Congenital heart disease, myocarditis, congestive heart failure, mitral valve defects and walls between the atria - play an important role in the development of secondary pulmonary hypertension. Compensatory increase in pressure occurs predominantly at defects and disorders associated with reset blood from the arterial to the venous blood flow, but the risk factor of disease is coronary heart disease also heart.
- Reception of drugs and medicines. For medications that increase the risk of developing the disease are amphetamine derivatives, is used to reduce appetite (fenfluramine, aminorex et al.) and psychostimulant drugs (amphetamine, cocaine).
- Systemic pathology. Secondary hypertension may be associated with liver cirrhosis, abnormalities of the hematopoietic system (hemoglobinopathy, myeloproliferative diseases), Autoimmune processes, pathological deposition of glycogen and glucocerebroside, dysfunction of the endocrine glands, and others. It was found that the activity of HIV infection significantly increases the risk of progressive hypertension.
Additional risk factors include:
- Lung pathology structure at chromosomal and genetic disorders;
- compression vessels during inflammation mediastinal lymph node and lung;
- the presence of benign and malignant neoplasms in the lymphatic and respiratory systems.
Signs and symptoms of the disease
Manifestations of hypertension may be masked by the clinical picture of other diseases. The main criterion for the diagnosis of the disease is the pressure in the pulmonary artery trunk 25 mmHg and higher. Against the background of the clinical picture of the underlying pathology nonspecific symptoms of hypertension may be bright It appears only in the last stages, when irreversible damage to endothelial and muscle layers pulmonary vessels.
Symptoms of pulmonary hypertension include:
- hoarseness, not associated with the inflammation of the throat and pharynx;
- dyspnea;
- weight loss;
- weakness, fatigue, even at low physical activity;
- palpitations;
- cough;
- dizziness, fainting.
The first symptoms of the disease develop in excess of twice the normal blood pressure in the pulmonary trunk (9-15 mm Hg). The intensity of the symptoms depends on the severity of circulatory disorders.
Signs of disease later stages could be chest pain similar to angina clinic, hemoptysis, unpleasant sensation in the right side, the deformation of the fingers in the form of "drumsticks" and edema of the lower extremities characteristic convex shape nails.
Classification
There are several classifications of hypertension: etiology, the presence of primary pathology and severity of symptoms and others. The main is the classification of severity, which reflects the lack of blood supply to the heart-lung. Allocate 4 class, degree or stage of hypertension:
- Pulmonary hypertension 1 degree - is a pathology that is not accompanied by characteristic symptoms of lack of oxygen and heart rhythm disturbances. In the first step, dizziness and weakness absent not only at rest and during daily activity, but also during exercise.
- In the second stage there is a decrease in exercise tolerance. The usual sports activity causes shortness of breath, rapid fatigue, weakness, in rare cases - chest pain.
- Pathology 3rd class called moderate pulmonary hypertension, provokes a significant reduction of physical activity. Even a small load is accompanied by symptoms of hypoxia.
- Severe hypertension manifests dyspnea, tachycardia and arrhythmia, severe weakness, chest pain, and dizziness. Symptoms of disease occur during everyday activity and at rest.
Features of the disease in children
Immediately after birth the newborn there is a high pressure in the pulmonary artery. This is due to the specifics of circulation in the first weeks of life of children: for 2-3 week blood pressure are within the normal adult.
Pathological pulmonary hypertension in children is associated mainly with the following diseases:
- chromosomal abnormalities (disease Patau and Edwards, trisomy of chromosome 21, etc.);
- hereditary and genetic disorders (sfingolipidozom, neurofibromatosis);
- congenital heart defects;
- systemic connective tissue disorders (lupus erythematosus, multiple sclerosis);
- obstruction of the pulmonary veins in conjunction with heart defects or in isolated form.
According to statistics, more than 70% of clinical cases of childhood hypertension cause congenital heart disease. In early surgical defect correction vascular remodeling and impaired muscle function layer does not occur, and the pathology of pulmonary artery regresses.
Abnormalities in the vascular endothelium and hypertension symptoms increase as the manifestation of a picture of the underlying disease and the development of the baby.
diagnosing
Examination with pulmonary artery hypertension is directed to diagnosis of underlying pathology and determination of the degree of disease severity. If you suspect a high pressure following studies are assigned:
- Electrocardiography and ultrasound of the heart. They are conducted to detect arrhythmias, cardiac chambers, and examination of the coronary arteries, blood flow monitoring and diagnosis of right ventricular failure.
- Radiography and CT scan. Thoracic expansion images detected major branches of the pulmonary artery and stenosis of small arterioles. Against the background of bulging main pulmonary vessels are observed and other circulatory disorders, including symptoms of the underlying disease of the respiratory and cardiovascular system. Down's syndrome and other chromosomal abnormalities are observed in a patient specific respiratory disorders.
- Cardiac catheterization and pulmonary trunk. With the catheter can be accurately set the blood pressure in the arteries and the right ventricle of the heart. The procedure is performed to confirm the diagnosis and detection of complications (heart failure, camera function).
- Angiography. Contrast study of the pulmonary veins and arterioles allows you to get a full picture of the vascular pattern and determine the degree of obstruction. diagnostic procedure is performed in the operating room because of the high risk of complications due to incorrect administration of contrast agent.
If necessary, the patient may be prescribed tests for hormones, genetic tests, or perfusion lung ventilation scintigraphy, measurement of respiratory function and others.
During the initial consultation, the patient's doctor analyzes the data history and symptoms of the disease, conducts auscultation and percussion of the lungs and heart.
How to treat
The treatment aims to decrease blood pressure in the pulmonary trunk, correction of the underlying disease, treatment of disorders in the endothelium and prevention of thrombosis.
Diet and lifestyle
With the development of hypertension need to take the following measures:
- abandon hormone replacement rate in menopause or oral contraceptives;
- conduct prevention of inflammation of the respiratory system;
- engage in physical therapy;
- possible to abandon the pregnancy and natural birth;
- do not engage in sports after meals, in cold or hot weather;
- to use an oxygen mask during the flight.
The diet should be aimed at maintaining a healthy heart and a normal hemoglobin level. The diet of the patient should preferably comprise plant foods and low-fat protein sources and iron (veal, liver, etc.).
Folk remedies
The use of the popular treatments for pulmonary hypertension should be agreed with the doctor (cardiologist or pulmonologist). Herbal infusions and decoctions can not replace a medical course, but can strengthen the diuretic effects of medicines and patient support immunity.
In hypertension, the following tools are used:
- broths hawthorn, valerian, chamomile, peppermint, and sage;
- infusions of mountain ash and viburnum;
- tea with clover;
- tincture of digitalis and mistletoe.
Physiotherapy
Cure pulmonary hypertension with the help of physiotherapy treatments can not. In severe symptoms of dyspnea and cerebral hypoxia patient appointed by inhalation with oxygen and nitrous oxide mixtures.
medicine
Hypertension drug therapy may include the following drugs:
- vasodilators;
- diuretics;
- anticoagulants;
- NSAIDs;
- iron supplements;
- cardiac glycosides;
- calcium antagonists and endothelin receptors;
- inhibitors fosfoesterazy et al.
surgical methods
When the low efficiency of the drug course or heart defects recommended surgery.
The operation can be carried out to create a contact between the atria, thrombus removal from the artery and its branches, as well as the transplantation of a healthy heart-lung complex (with severe primary hypertension and certain vices heart).
prevention
Prevention of pulmonary hypertension suggests early diagnosis of the disease or correction of pathologies that can lead to its development. To do this, you must be regularly examined by a cardiologist, and X-ray light.
Prognosis and complications
Pulmonary arterial hypertension leads to the development of severe complications of the cardiovascular system. These include atrial fibrillation, thromboembolism and major vessels of the heart, pulmonary hypertensive crises, right ventricular failure, and others.
With the rapid progression of the disease and the development of primary hypertension patients with average life of 2-3 years. Ten-year survival rate of patients after transplantation cardiopulmonary complex or good response to therapy of endothelin antagonists is more than 50%.
The worst prognosis (less than one year of life) is characterized by hypertension, which developed against the background of scleroderma.
