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General Practice 2023

Hypertensives&pulmonary activity: symptoms, causes and treatment

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Hypertensives&pulmonary activity: symptoms, causes and treatment
Hypertensives&pulmonary activity: symptoms, causes and treatment

Pulmonary hypertension is high blood pressure in the blood vessels that supply the lungs, caused by increased stiffness in the pulmonary arteries or by an obstruction caused by clots, for example. This disease can also cause damage to the right side of the heart, because as the lungs cannot capture oxygen efficiently, it takes a greater effort from the heart to pump blood and oxygenate all tissues in the body.

This type of disease can affect people of all ages, including babies, but it is more common in women over 30 and in people with other heart diseases such as heart failure or lung diseases such as chronic obstructive pulmonary disease, for example.

Pulmonary hypertension is a serious condition that can cause symptoms of shortness of breath, swelling in the legs, or heart palpitations.Therefore, when pulmonary hypertension is suspected, it is important to consult a pulmonologist so that the diagnosis can be made, the cause identified and appropriate treatment initiated, which may include the use of medication, surgery or lung transplantation.

Main symptoms

In an early stage, pulmonary hypertension usually has no symptoms, however, a symptom that can arise is the feeling of shortness of breath that occurs during exertion, and as the disease worsens or becomes more severe, it can happen even at rest.

In more advanced stages, other symptoms may appear, such as:

  • Excessive fatigue;
  • Dizziness or fainting;
  • Swelling in the ankles or legs;
  • Swelling in the abdomen;
  • Chest pain;
  • Heart palpitation;
  • Accelerated pulse;
  • Difficulty breathing;
  • Blue color on lips or skin.

It is important to consult a pulmonologist as soon as these symptoms appear, or to seek the nearest emergency room, in order to initiate the most appropriate treatment.

How to confirm the diagnosis

The diagnosis of pulmonary hypertension is difficult and the doctor is not always able to detect the condition in routine exams. Even when the disease is more advanced, the symptoms are often similar to those of other heart and lung diseases.

Therefore, the diagnosis of pulmonary hypertension must be made through the evaluation of the clinical history, physical examination and performance of several tests such as blood, chest X-ray, computed tomography, magnetic resonance, electrocardiogram, echocardiogram, pulmonary function test, polysomnography and pulmonary ventilation and perfusion test.

To confirm the results, the doctor may also request a catheterization, which allows measuring the pressure inside the pulmonary artery and performing a lung biopsy, to evaluate damage to the lung cells.

Possible causes

The causes of pulmonary hypertension can be classified according to the origin of the disease, and include:

1. Primary pulmonary hypertension

Primary pulmonary hypertension, also known as pulmonary arterial hypertension, can occur due to changes in the formation of pulmonary vessels, usually due to unknown causes, being, in this case, called idiopathic, but it can also occur due to:

  • Inheritance by genetic alterations in the family;
  • Use of medications such as fenfluramine, dexfenfluramine or selective serotonin reuptake inhibitors;
  • Use of drugs of abuse such as methamphetamine or cocaine;
  • Inborn heart problems such as congenital heart failure;
  • Schistosomiasis.

In addition, diseases such as scleroderma, lupus, HIV infection, or cirrhosis can also cause primary pulmonary hypertension.

2. Secondary pulmonary hypertension

Secondary pulmonary hypertension is more common and usually develops as a complication of other diseases such as:

  • Heart failure;
  • Mitral valve disease;
  • Cardiomyopathy;
  • Lung emphysema;
  • Chronic obstructive pulmonary disease;
  • Sleep Apnea;
  • Thrombosis or pulmonary embolism;
  • Pulmonary fibrosis;
  • Inflammatory diseases such as sarcoidosis or vasculitis;
  • Blood diseases such as polycythemia vera or thrombocythemia;
  • Metabolic disorders such as glycogen storage disease;
  • Kidney failure;
  • Tumors that can press on the pulmonary arteries.

All these causes cause narrowing or blockage of the pulmonary arteries, hindering the circulation of blood within the lung and the ability of this organ to capture oxygen from the breath, which makes the heart make more effort to pump blood and take oxygen to other parts of the body, increasing the risk of complications.

How the treatment is done

Treatment for pulmonary hypertension should be guided by the doctor and aims to control the disease, treat the cause, relieve symptoms and/or prevent the disease from getting worse. So it can include:

1. Use of medication

The medications that the pulmonologist can prescribe to treat pulmonary hypertension are:

  • Vasodilators such as epoprostenol, treprostinil or iloprost: help relax and open narrow blood vessels, improving blood flow within the lungs;
  • Guanylate cyclase stimulators such as riociguat: relax the pulmonary arteries and reduce the pressure inside the lungs;
  • Endothelin receptor antagonists such as bosentan, macitentan or ambrisentan: block the effect of endothelin, a substance present in the walls of blood vessels that causes the pulmonary arteries to narrow;
  • Phosphodiesterase inhibitors such as sildenafil or tadalafil: These are commonly used to treat erectile dysfunction, but they also open up blood vessels in the lungs and allow blood to flow more easily;
  • Antihypertensives such as amlodipine, diltiazem or nifedipine: help relax the muscles around the blood vessels in the lungs, improving blood circulation;
  • Anticoagulants such as warfarin: decrease blood viscosity, preventing the formation of clots that can cause pulmonary embolism;
  • Diuretics such as furosemide or indapamide: they help to remove excess fluids from the body, preventing them from accumulating in the lungs, legs or abdomen, in addition to reducing the effort of the heart to pump blood.

The doctor may also indicate the use of antiarrhythmics such as digoxin, in cases where pulmonary hypertension has been caused by heart problems, as these drugs help to strengthen the heart muscle, facilitating contractions and allowing more pumping blood flow to the body.

2. Oxygen Therapy

Oxygen therapy consists of inhaling oxygen in a concentration greater than normal, with the aim of guaranteeing oxygenation of all tissues of the body. This therapy should be indicated by the doctor according to the person's blood oxygen rate.

Oxygen therapy is used especially for people who live at a high altitude or who have sleep apnea. In some cases, continuous use of oxygen may be necessary. Understand better how it works and the main types of oxygen therapy.

3. Lung surgery

In cases where medications are not effective in controlling pulmonary hypertension or in more severe cases, the doctor may recommend some types of surgery which include:

  • Pulmonary endarterectomy: this surgery allows the removal of old blood clots from the pulmonary arteries in people with chronic thromboembolic pulmonary hypertension;
  • Lung angioplasty: a small balloon is inserted into the arteries and inflated for a few seconds to unblock and restore blood flow to the lung;
  • Atrial septostomy: is done in the wall between the left and right atria of the heart to reduce pressure on the right side of the heart, allowing the heart to pump blood more efficiency and that blood flow to the lungs can be improved.

These surgeries allow you to unclog the blood vessels inside the lungs and/or improve blood flow, which helps to control the symptoms of high blood pressure.

4. Lung transplant

Lung, or lung and heart, transplantation may also be a treatment option, especially for younger people who have idiopathic pulmonary arterial hypertension.

These transplants can also be performed when other treatment options are not effective in controlling the symptoms of high blood pressure, being the last treatment option.

The main risks of transplantation include rejection of the transplanted organ and severe infection, so you should take immunosuppressive drugs for the rest of your life to help reduce the chance of rejection.

Possible complications

Complications of pulmonary hypertension can arise in later stages of the disease and include:

  • Heart failure;
  • Thrombosis or pulmonary embolism;
  • Cardiac arrhythmia;
  • Bleeding from lungs.

In addition, pregnant women who have pulmonary hypertension are at increased risk of complications, especially in late pregnancy or postpartum, which can be life-threatening.

Pulmonary hypertension of the newborn

Pulmonary hypertension of the newborn, also called neonatal persistent pulmonary hypertension, arises when there is a change in the blood circulation of the baby's lungs and heart, which causes difficulty in oxygenating the body, causing symptoms such as difficulty breathing, bluish lips and fingers and swelling in the body. The baby's pulmonary hypertension usually happens due to asphyxia inside the uterus or during childbirth, pneumonia, hypothermia, hypoglycemia, or the mother's use of drugs in excess, such as indomethacin or aspirin, for example.

The treatment is done using oxygen therapy, with a mask or in an incubator, keeping the baby warm and pain-free, in addition to medication or procedures to correct heart defects. In the initial and more severe phase, it may also be necessary to breathe with the help of devices, which can be removed after the signs and symptoms improve.

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