Pulmonary hypertension: symptoms, treatment, prognosis, diagnosis, classification

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This disease, along with pulmonary embolism and pulmonary heart refers to the ailments of the small circle of blood circulation. Presenting a pathological condition in the pulmonary system, pulmonary hypertension is characterized by a sharp and significant increase in the pressure in the pulmonary artery. With a blood pressure reading above 35 mm Hg. Art.already can be diagnosed with "pulmonary hypertension".

Features of the disease

This disease begins to progress in the presence of one of the two main reasons - either there is excessive pressure in the pulmonary artery due to a significant increase in blood flow, or there is increased pressure at a constant volume of pulmonary blood flowing with a significant increase in pressure inside the artery itself. Presenting a complicated developing pathological process in the lungs, pulmonary hypertension can become a serious danger for the patient: some of its forms( for example, pulmonary hypertension in some autoimmune states and idiopathic pulmonary hypertension) progress rapidly and become a direct cause of manifestation of respiratory failure with a probable fatal outcome.

Development of this pathological process is characterized by rapidity, it involves a large number of components and the negative impact of this disease affects the work of other organs and systems.

The following video will describe in an accessible form the essence of the disease of pulmonary hypertension:

In infants

Pulmonary hypertension may occur in newborns. And here development of one of two kinds of the given state can be observed:

• the primary form;
• secondary form.

The primary form of pulmonary hypertension in newborns is characterized by a virtually complete absence of pathology in the lung system, external symptoms are also absent. Diagnosed only an increased amount of carbon dioxide in the lungs, or its amount is within normal limits.

The secondary form of pulmonary hypertension in infants is characterized by the presence of severe lung lesions that have severe manifestations of parenchymal abnormalities. With secondary pulmonary hypertension, the prognosis is much worse in comparison with the primary form of this disease.

The most common cause of the present pathological condition of the lungs in newborns is the appearance of a congenital diaphragmatic hernia, which deforms the lung, and the second lung thus receives an excessive amount of blood, which provokes the emergence of hypertension of the lung. Neonatal sepsis, which is also considered one of the causes of this condition in infants, is less common.

An additional reason for the development of pulmonary hypertension in infants is the sudden pressure surge that originated in the pulmonary system. If the body does not cope with a new level of exercise, then pulmonary hypertension begins to manifest.

The manifestation of the disease is the occurrence of severe dyspnea, and the appearance of a high rate of development of cyanosis in the syndrome of pulmonary hypertension. Rapid development of the pathological process in newborns is very dangerous: in the absence of the necessary treatment, the baby is at risk of a fatal outcome within a few hours after the first signs of the disease manifest.

Children

The main difference between pulmonary hypertension in children from adults is the possibility of the development and further progression of the pathological condition of the pulmonary system as a result of ontogenesis in the lungs and in the vessels of the lungs, which especially occurs in the perinatal period. Disturbances and the development of pathological abnormalities are possible as a result of any external influences, which also provoke a slowdown in the overall development, growth and adaptation of the child.

Congenital heart disease, the presence of lesions( congenital or acquired) can be a starting factor in the development of pulmonary hypertension in children. Chronic lung diseases also often cause pulmonary hypertension in childhood.

Schematic diagram of pulmonary hypertension

Classification of pulmonary hypertension by degree

Pulmonary hypertension has a variety of forms that are classified according to several key features. To such indicators, distinguishing the types of disease, are:

• pulmonary heart - the degree of its development;
• disturbances in ventilation;
• presence of X-ray and electrocardiographic signs;
• expressed disorders in hemodynamics.

There is a division of the examined pathological condition into three degrees. Let us consider them in more detail. And we will start with a story about what is pulmonary hypertension of 1 degree, and how this disease manifests itself.

The following video shows how dangerous pulmonary hypertension in newborns and children is more dangerous:

The first( transitory) degree of

• The first degree of development of this disease is characterized by the absence of obvious signs of lesion of the pulmonary system, which can be observed during X-ray examination. Probably appearance of some manifestations of respiratory failure.
• The first degree of pulmonary hypertension is difficult to diagnose, but the detection of the disease in the first degree allows to localize the process and rather cope with the manifestations of the disease.

About what it is and how the pulmonary hypertension of the 2nd degree proceeds, read further.

Second( stable) degree

• The second degree is characterized by the appearance of dyspnea with the same degree of physical exertion that did not previously cause such a condition. Perhaps the appearance of apical cardiac shock, which is a direct sign of the formation of the pulmonary heart, and with an X-ray examination, the initial stage of pulmonary hypertension can easily be revealed.
• With x-rays, clearly pronounced swelling of the outlines of the pulmonary artery, which is caused precisely by the increase in the degree of blood pressure in it. Probably an increase in the volume of the roots of the lungs. When examining a patient, signs of oxygen deficiency in the patient's tissues are revealed.

Third degree

• For the third degree of disease, the appearance of diffuse cyanosis becomes characteristic, which will differ in characteristic gray, "warm" color.
• There are signs of an increase in the liver, on the neck may swell the veins.
• With X-ray examination, it is possible to observe an increase in the volume of the right ventricle of the heart, which occurs as a result of an increase in pressure and a general load on it.expressed metabolic acidosis.

Causes of

The onset of pulmonary hypertension is possible both independently and in the presence of the underlying cause. Depending on the type of pulmonary hypertension, the causes that caused this condition are somewhat different.

Primary hypertension

Primary hypertension, or not having a clear cause, is the least studied form of this pathological condition. Its reasons are usually the following:

• the presence of genetic disorders, which are laid in the process of embryonic development;
• is insufficient to reproduce specific substances that are responsible for the process of constriction and expansion of vessels in the lungs - it also directly depends on the genome and heredity;
• excessive aggressiveness and increased activity of platelets, resulting in the risk of blockage of blood vessels and arteries by platelets.

It is also likely the development of fibrosis in the lung tissue, in which there is an excessive growth of the tissue of the vessels of the lungs, while also narrowing the lumen of blood vessels and arteries and, consequently, increasing the level of pressure in them.

Secondary hypertension

There may be many objective factors for the onset of secondary pulmonary hypertension, which may include:

1. obstructive pulmonary disease with chronic course - for example, COPD, congenital heart disease;
2. lesions of thrombotic character of pulmonary tissue vessels;
3. hypoxic condition, or Pickwick syndrome;
4. cardiovascular disease.

In addition to the listed reasons for the occurrence of secondary pulmonary hypertension, ischemic lesion, which occurs in the left ventricle of the heart, should also be attributed. The presence of aortic valve defects, pulmonary arterial hypertension and its effect on the operation of the left ventricle are also considered objective and serious causes of the disease in question.

Also, the functional mechanism that can cause manifestations of pulmonary hypertension should be considered an increase in the minute amount of blood, the effect on the veins of light biologically active substances, an increase in blood viscosity due to the development of infectious conditions in the bronchi and lungs. Next we will tell you about the signs of pulmonary hypertension.

Symptoms of

Because the present lung condition is multicomponent, its symptoms are very diverse. However, the earliest symptom of the disease should be considered the appearance of dyspnea - first it is detected only with an increase in physical activity, then begins to manifest itself and with a small load, and then it becomes a constant companion of the patient.

This manifestation is associated with a gradual change in the degree of performance of its direct functions by the lungs, affecting the tissues of the vessels and arteries. The narrowing of the lumen in the vessels of the lungs increases the blood pressure, which can grow 2 or more times compared to the nome.

Further progression of the disease is characterized by the appearance in the expectorated sputum of a patient with blood veins, which is associated with a gradual "sweating" of blood cells and plasma through the walls of blood vessels due to high blood pressure in them. The blood sputum in the sputum is first detected a little, then this amount increases.

Pulmonary hypertension with its further progression will have such a symptomatology:

• change in skin condition - cyanosis appears;
• the shape of the fingers also changes - they become like drumsticks;
• change of nails, which acquire a characteristic kind of watch glass - this is a consequence of deterioration in the quality of nutrition of tissues with narrowing of blood vessels and a decrease in blood flow velocity.;
• when listening to the rhythms of the heart through the stethophonendoscope will hear the amplification of sounds when the heart valve is met with high blood pressure;
• the appearance of soreness in the heart that disappears with regular oxygen inhalation;
• occurrence of fainting, which can last from 2 to 20-25 minutes;
• the most striking symptom of the disease should be considered the appearance of the so-called pulmonary heart, which is accompanied by an increase in soreness in the heart, heart murmurs, the appearance of palpitations and increased weakness.

Increased liver size and cervical vein swelling is also considered a sign of a change in the state of pulmonary mechanisms.

Diagnostics

Early diagnosis of pulmonary arterial hypertension allows time to stabilize the patient's condition and improve his condition, stopping the disease at the initial stage.

Description of patients with their condition allows you to put a preliminary diagnosis, which is compared with the clinical picture. To verify the diagnosis, the following methods are used:

1. electrocardiogram, which allows to see and analyze the condition and work of the heart;
2. X-ray examination of the chest;
3. holding of the FCG and VKG;
4. receiving hemodynamic results by catheterization of the right heart and lung arteries;
5. further establishes membership in a certain class of pulmonary hypertension, for which MRI is performed, computed tomography of the lungs and blood vessels;
6. can be administered a lung tissue biopsy.

Treatment of

Several main methods are used for the treatment of pulmonary hypertension, the combination of which allows to quickly stabilize the patient's condition and prevent further development of the pathological process.

The most effective methods of treating the disease include therapeutic, medication, as well as folk methods and surgical intervention, we will consider them in more detail.

Therapeutic

As a therapeutic method with high effectiveness, oxygen therapy should be used, which allows saturating the body's tissues with oxygen and eliminating the negative effect of its deficiency on the patient.

For this procedure, the amount of oxygen must be carefully calculated, and in the case of hypercapnia, the degree of oxygen concentration decreases.

Bloodletting can also be performed - for the first bloodletting the patient is taken about 500 ml, and the next few days, after a couple of days after the first bleeding session, 300 ml. This method lowers blood pressure on the vessel walls and improves the patient's condition.

An important method of therapeutic treatment is the complete exclusion of the aggravating factors of the patient - staying in a mountainous area, excluding large physical exertion, pregnancy.

Surgical

Surgery also shows high effectiveness, since the absence of pronounced efficacy in the proposed drug treatment to save the life of the patient should resort to surgery. It consists in conducting atrial septotomy, which improves the movement of blood through a large range of blood circulation.

Lung transplantation or a "heart-lung" complex may also be indicated. This method of surgical intervention can be shown only in severe form of the disease, and for its carrying out there are several contraindications that limit the possibility of conducting a transplant. Contraindications include elderly age, patient's weakness and poor state of health, as well as the level of oxygenation of the blood.

Medication

In the treatment of pulmonary hypertension, medications are usually prescribed by a doctor and used under his supervision. These funds include the following:

• glucocorticoids, used in limited quantities;
• antihistamines;
• acetylsalicylic acid, which improves radiographic indices of blood;
• bronchodilator drugs are used to increase the patency of the bronchi;
• for the dilatation of the vascular ducts of the lungs is used the vasodilator drug Zufillin, which also allows improving blood flow, stimulating blood flow and diuresis. It is used in the form of tablets, intravenous or candles, but it should be used carefully: the drug increases the demand for myocardium in the supply of oxygen.

To improve the separation of sputum, mucolytic agents are prescribed, for the same, steam inhalations, respiratory exercises are used.

Used for the treatment of pulmonary hypertension diuretics - they should also be used carefully, because excessive use leads to an increase in blood viscosity, which causes the active formation of blood clots and increases the risk of clogging of blood vessels with a formed thrombus.

Calcium antagonists, relaxing on the smooth muscles of the lungs, can relieve the increased stress in them and also improve blood flow.

Treatment with folk remedies

Treatment with folk remedies can reduce unpleasant sensations in pulmonary hypertension, therefore their use is not limited.

• For example, pumpkin juice can reduce blood viscosity and eliminate the risk of blood clots in the vessels.
• Juice made from ashberry allows to increase blood circulation in the lungs, which is also important for stimulating blood circulation during the treatment of the disease.

Prevention of

In order to prevent pulmonary hypertension, the following recommendations can be given:

• to maintain a healthy lifestyle and exclude bad habits such as smoking, alcohol intake;
• regular exercise will help to always have active blood circulation and avoid the formation of blood clots;
• food should be full and balanced - fresh vegetables and fruits will help saturate the body with vitamins and effectively resist the infectious and viral diseases.

Regular check-up with the doctor will also allow to detect the disease in time.

Complications of

• If the treatment is insufficient, the primary stage of the disease becomes secondary, which aggravates the symptoms and worsens the patient's condition.
• Insufficiency of feeding tissues with oxygen leads to shortness of breath, which gradually increases and can occur even without physical exertion. Also hypoxia causes an increase in the degree of viscosity of the blood, and this can cause blood clots in the blood that can clog the vessel in the lung.

So, you already know about the symptoms and recommendations for the treatment of pulmonary hypertension, so further you will learn about the prognosis regarding the disease.

Prediction

Pulmonary hypertension, being a serious disease, requires immediate treatment, because the lack of exposure to the patient's body or insufficiently applied treatment leads to a worsening of the pathological process and there is a risk of death.

• With idiopathic pulmonary hypertension, if there is no possibility of influencing the disease-provoking factor, the forecast is most depressing: the predicted five-year survival of patients is about 12-21%.
• If the treatment of the disease was started immediately after its detection and there is a pronounced result, the forecast is 28-39%.

The following video contains even more useful and important information on the issue of a disease such as pulmonary hypertension: