Pulmonary Hypertension

Definition

Pulmonary hypertension is a type of high blood pressure that affects only the arteries in the lungs and the right side of your heart.

Pulmonary hypertension begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, which raises pressure within the arteries in your lungs. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail completely.

Symptoms

The signs and symptoms of pulmonary hypertension in its early stages may not be noticeable for months or even years. As the disease progresses, symptoms become worse. Pulmonary hypertension symptoms include:
  • Shortness of breath (dyspnea), initially while exercising and eventually while at rest, Fatigue, Dizziness or fainting spells (syncope), Chest pressure or pain
  • Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites), Bluish color to your lips and skin (cyanosis), Racing pulse or heart palpitations.

Causes

Your heart has two upper and two lower chambers. Each time blood passes through your heart, the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery). In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart.

Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs. With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes cause extra tissue to form, eventually narrowing or completely blocking the blood vessels, making the arteries stiff and narrow. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries.

Tests and diagnosis

Pulmonary hypertension is hard to diagnose early because it’s not often detected in a routine physical exam. Even when the disease is more advanced, its signs and symptoms are similar to those of other heart and lung conditions. Your doctor may do one or more tests to rule out other possible reasons for your condition. The first tests you’ll have to diagnose pulmonary hypertension include:
  • Chest X-ray:This test may be able to check for pulmonary hypertension if your pulmonary arteries or the right ventricle of your heart is enlarged. The X-ray will appear normal in about one-third of people who have pulmonary hypertension.
  • Echocardiogram:Your doctor may first suspect you have pulmonary hypertension based on the results of this test. This noninvasive test uses harmless sound waves that allow your doctor to see your heart without making an incision.During the procedure, a small, plastic instrument called a transducer is placed on your chest. It collects reflected sound waves (echoes) from your heart and transmits them to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor.
  • Transesophageal echocardiogram:If it’s difficult to get a clear picture of your heart and lungs with a standard echocardiogram, your doctor may recommend a transesophageal echocardiogram. In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus using only a numbing spray in the back of your throat. From here, the transducer can get detailed images of your heart.