Pulmonary Hypertension
Pulmonary hypertension is a global health issue that can be treated early. It occurs when the pressure in the blood vessels leading to the lungs is too high. When left untreated, the right heart, which pumps blood to the lungs, will enlarge and fail. In the end, blood does not flow as well as it should to the lungs, resulting in less oxygen in the blood.
Symptoms
The symptoms of pulmonary hypertension in the early stage, are common to other medical conditions. As a result, diagnosis is often delayed.
Early:
Fatigue.
Breathlessness when bending forward and on progressively minor physical exertion.
Palpitations.
Coughing out blood.
Abdominal distension and nausea. Swelling over both legs.
Fainting episodes during or shortly after physical exertion.
Late:
Chest pain on physical exertion from compression of the left main coronary artery.
Hoarseness of voice from compression of the left recurrent laryngeal nerve.
Cough and wheezing from compression of the windpipe.
Who are at risk?
Prevalence of about 1% of the global population. All age groups are affected, but the prevalence is higher in those > 65 years old.
Diagnosis
Pulmonary hypertension is suspected when there is elevated pulmonary arterial pressure on a trans-thoracic echocardiogram. Patients can be risk stratified into low, intermediate to the high probability of pulmonary hypertension.
Diagnosis is confirmed by a right and left heart catheterization.
Treatment
Patients are then classified into 5 clinical groups, each with different treatment strategies.
| Group 1 | Group 2 | Group 3 | Group 4 | Group 5 |
| Pulmonary arterial hypertension (rare) | Pulmonary hypertension associated with left heart disease (very common) | Pulmonary hypertension associated with lung disease (common) | Pulmonary hypertension associated with pulmonary artery obstruction (rare) | Pulmonary hypertension with unclear and/or multifactorial mechanisms (rare) |
| -Heritable -Associated with drugs and toxins -Persistent pulmonary hypertension of the newborn -Pulmonary arterial hypertension with features of venous/ capillary involvement -Associated with: • Connective tissue disease • HIV infection • Portal hypertension • Congenital heart disease • Schistosomiasis | -Heart failure -Valvular heart disease -Congenital /acquired cardiovascular conditions leading to post-capillary pulmonary hypertension | -Obstructive lung disease -Restrictive lung disease -Lung disease with mixed restrictive / obstructive pattern -Hypoventilation syndromes -Hypoxia without lung disease (high altitude) -Developmental lung disorders | -Chronic thromboembolic pulmonary hypertension -Other pulmonary artery obstruction | -Haematological disorders -Systemic disorders -Metabolic disorders -Chronic renal failure with or without dialysis -Pulmonary tumour thrombotic microangiopathy -Fibrosing mediastinitis |
| Therapeutic strategies | ||||
| Medication: -Pulmonary hypertension drugs Lung transplantation | Treatment of heart disease. Potentially pulmonary hypertension drugs (trials). | Treatment of lung disease. Potentially pulmonary hypertension drugs (trials). | Surgical therapy: -Pulmonary endarterectomy Interventional: -Balloon pulmonary angioplasty Medication: -Pulmonary hypertension drugs | Treat underlying disease. Potentially pulmonary hypertension drugs (trials). |
*Information is obtained from the Centers for Disease Control and Prevention, as well as the European Society of Cardiology guidelines.
Author:
Dr. Kenneth Guo’s – Cardio-G
MBBS, MRCP (U.K.), MMed (Int Med), FAMS (Cardiology)
Clinic Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #07-27 Singapore 329563 Tel: +65 6902 4371