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What Is Pulmonary Hypertension?

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Pulmonary hypertension is a condition affecting the arteries of the right side of the heart and the lungs. It is a harmful type of blood pressure disease and affects the lungs in various forms. Check out https://pvrinstitute.org  to learn more about what is pulmonary hypertension.

What does pulmonary hypertension entail?

Deoxygenated blood travels from the heart’s right ventricle to the lungs through pulmonary arteries in the human body. The lungs then filter and oxygenate the blood, making it safe to be carried to other organs. 

Due to multiple reasons, the blood pressure in pulmonary arteries may escalate, causing the arteries to debilitate. This increased pressure also enervates the cardiovascular muscles, and the patient has to face many problems.

What causes pulmonary hypertension?

The heart has two upper chambers, the atria, and two lower chambers, the ventricles.  Once the arteries bring the blood to the lungs from the ventricle, it undergoes gaseous exchange. However, specific circumstances can lead to changes in the lining of the cells of the pulmonary arteries. 

These cause the stiffening, thickening, and swelling of the arteries. This change in the anatomical structure also stunts the blood flow and leads to pulmonary hypertension. 

There are various groups of causes leading to hypertension and arterial anatomy change. Each of the groups is discussed below.

Common reasons behind pulmonary arterial hypertension 

Pulmonary arterial hypertension is usually idiopathic, so the precise causation is not established. However, doctors that collect data from blood pressure patients observe a correlation between this condition and some other factors. These constitute potential reasons like:

Hereditary causes

Pulmonary Arterial Hypertension can classify as hereditary as it can pass down the generations due to gene mutations. Consequently, the progeny is also likely to suffer from it. So, if an individual has PAH in family history, he/she can be more prone to acquiring the condition. 

Drug abuse

Drug use can also play a role in the development of pulmonary hypertension. It is especially true when the drugs are psychoactive or alter the way the brain functions. Their chemicals often over-stimulate the nervous system, which then generates abnormal signals. It includes the release of hormones like dopamine from the reward system in the brain. The euphoric high often prompts an adrenaline rush, so the user experiences a rush of blood and a heartbeat surge.

The frequent and unnecessary stimulation of the heart through drug addiction can drain the arteries and impair the heart muscles. So, the overwhelmingly high blood pressure due to drug abuse can provoke pulmonary hypertension. Drugs like methamphetamines and some diet-related drugs are more likely to cause this condition.

Congenital heart issues

Some babies suffer from congenital disabilities and are born with heart complications. These can include the condition of having a “hole in the heart,” medically known as a septal defect. The arteries and valves may have an abnormal size or shape, as typical in the aorta’s coarctation. In some other instances, the entire heart may be underdeveloped.

These issues indicate that their heart needs extra help to operate correctly and that they are more susceptible to develop other heart issues when they grow. It can also cause arterial distension or blockage as the heart cannot pump blood efficiently. 

The role of left-sided heart diseases in pulmonary hypertension

The blood leaves the lungs to enter the left side of the heart. If an individual suffers from left-sided heart disease, the heart’s pressure when pumping blood causes arterial distension. In this state, the blood rushing through the arteries exerts an overwhelming outward force on their walls. So, the arteries swell and augment to an abnormal size.

Here are some of the left-side heart disorders that can trigger such complications:

Mitral and aortic valve disease

The Aortic and Mitral are two main valves present in the left side of an individual’s heart. The Mitral valve is identifiable between the left atrium and the left ventricle. Due to old age, genetic factors, or radiation exposure, it can stop performing. It may constrict in size or may not close at an appropriate time. The dysfunction of the Aortic valve can also elevate the blood pressure and damage the pulmonary arteries.

Consequently, the heart beats irregularly and with an abnormally high blood pressure, leading to pulmonary hypertension.

Failure of the left ventricle

According to studies conducted in the US, left ventricle failure is the most leading cause of pulmonary hypertension. People with coronary heart diseases or a history of long-term battle with high blood pressure are more likely to suffer from left ventricle failure. When it happens, the hypertrophy of the heart’s left side makes it incapable of pumping blood continually. The blood regurgitates into the lungs, exerting a force on pulmonary arteries, adding to the risk of pulmonary hypertension.

Lung diseases and pulmonary hypertension

Because the lungs receive the blood from the heart and purify it, lung diseases can obstruct the entire procedure. Some of them hinder blood flow and gaseous exchange and can potentially cause pulmonary hypertension.

These include the following:

  • Chronic inflammatory diseases

When an individual’s lungs have to deal with poisonous gases regularly, they may develop chronic inflammatory diseases. These are prevalent in smokers and passive smokers, as the cigarette smoke is full of carcinogens and harmful gases. The inflammation of their lungs causes excess mucus secretion, wheezing, and coughing. It also places them at the risk of developing chronic bronchitis and emphysema. People with inflammatory lung diseases often develop COPD (Chronic Obstructive Pulmonary Disorder). It levitates the blood pressure, and eventually, pulmonary hypertension follows.

  • Pulmonary fibrosis

When a person is exposed to the chemicals present in hard metals, silica dust, asbestos, or coal dust, their lung tissue becomes scarred. When the interstitium, the tissue between the air sacs or alveoli, acquires damage, the condition is called pulmonary fibrosis.

It causes people to suffer from muscle and joints aches, dry cough, and shortness of breath. Pulmonary Fibrosis also raises the diastolic and systolic blood pressure, which frequently results in pulmonary hypertension.

Chronic blood clots and other health conditions 

When blood thickens to form clots, they block and distend the arteries. If left untreated, they can lead to critical arterial damage by dislodging or blocking other vessels. It often results in internal bleeding or hemorrhage. Blood clots can cause pulmonary hypertension if they are at the level of the patient’s lungs. Such clots are known as pulmonary emboli. Their blockage of arteries results in a lack of blood flowing to vital organs. Some other clotting disorders, like clotting due to high cholesterol levels, can also contribute to hypertension.

Other health conditions causing pulmonary hypertension and arterial thickening, swelling, or blockage are:

  • Blood diseases like polycythemia vera and essential thrombocythemia
  • Vessel inflammatory disorders like sarcoidosis and vasculitis
  • Metabolic disorders like glycogen storage disease
  • Kidney diseases
  • Tumors that suppress the arteries 
  • Residing at high altitudes where there is low blood pressure
  • Obstructive sleep apnea

How to identify pulmonary hypertension?

The most straightforward way of identifying the condition would be to visit a cardiologist. However, it is also identifiable through the symptoms and signs it manifests.

Individuals with pulmonary hypertension often complain of angina or chest pain. It is frequent during strenuous exercise, sports, or anything that requires the muscles to work actively. This chest pain comes with a stabbing sensation, and it occurs because the circulatory system is incapable of providing the muscles with the blood they require. This struggle creates a strain on the heart, so patients report chest or heart pain.

Patients with pulmonary hypertension also suffer from palpitations or a racing heartbeat. Their pulse may become inexplicably ectopic, and they are painfully aware of the abnormal pounding of their heart. Their abdomen, arms, and legs may appear swelled or bloated, and their skin may develop a blue tinge. Patients are also likely to feel dizzy while walking or standing, and they require more frequent breaks than a healthy person. Most of these complications directly result from a lack of blood flow to organs.

How do experts diagnose pulmonary hypertension?

When individuals visit their doctor with any of the symptoms commonly found in pulmonary hypertension, their doctor will ask some critical questions to help them diagnose. These pertain to the patient’s family history, congenital disabilities, and other medical complications that they face. Alongside the discussion, doctors are likely to prescribe a blood test and chest X-ray. The X-ray provides a visual representation and can determine whether there is a problem with the heart’s chambers.

An Electrocardiogram or ECG is also expected during the diagnosis of pulmonary hypertension. It is an external test that records the heart’s movements, so abnormal heartbeats and blood pressure can be detected. Some practitioners also refer to an Echocardiogram for diagnosis, as its sound waves can reveal the ventricles’ health.

Once the cardiologist observes concrete indications of pulmonary hypertension, they may conduct a right heart catheterisation for confirmation. It includes inserting a catheter or a thin tube into the neck of the patient. It provides a pathway to the right ventricle and pulmonary arteries, allowing the doctor to assess the blood pressure.

Elena Deeley did her degree in psychology at the University of Edinburgh. She has an ongoing interest in mental health and well-being.

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