Pulmonary Hypertension

Pulmonary Hypertension Pulmonary hypertension is high blood pressure in a small circulation (average resting blood pressure> 25 mmHg, in terms of effort> 30 mmHg). In the pulmonary circulation (also called small circulation) from the right ventricle blood is pumped into the lungs where it receives oxygen and returns to the heart ventricle. The left ventricle then pumps oxygenated blood into the systemic circulation (heavy traffic) to irrigate their organs. For this we need a blood pressure (average pressure 100 mmHg). Systemic circulation blood ends when the carbon dioxide back again to the heart in the right ventricle. Healthy individuals have low blood pressure always in the pulmonary circulation, both at rest and in physical condition (mean blood pressure 15 mmHg).
Etiology For unknown reasons, blood vessels in the lungs (pulmonary arteries) shows a tendency of narrowing (vasoconstriction) in patients with chronic pulmonary hypertension. Furthermore, platelets adhere to blood vessels and cells of the endothelium of blood vessels tend to proliferate strongly, leading to additional narrowing of the internal diameter. These three factors lead to high blood pressure in the lung. When the right ventricle has to counteract a high voltage that occurs over time, the heart pumping capacity gradually decreases, leading to heart failure. Case changes of pulmonary artery endothelial dysfunction represents an (internal wall of blood vessels), characterized by excessive production of vasoconstrictor substances (eg endothelin and thromboxane) and vasodilators deficit protective substances. Platelets can accumulate more easily on the internal wall of blood vessels, leading to the formation of small blood clots. In primary pulmonary hypertension (the cause of idiopathic) have an important role and genetic predisposition. Depending on the triggering factor, it can make the following classification: 1. Pulmonary arterial hypertension; 2. Pulmonary hypertension due to left heart failure; 3. Pulmonary hypertension due to pulmonary pathology or lack of oxygen; 4. Chronic pulmonary hypertension due to embolism of pulmonary arteries; 5. Pulmonary hypertension caused by rare diseases;
Clinical Symptoms of pulmonary hypertension do not appear until after narrowing a large number of blood vessels obviously cause high blood pressure in the lung. Symptoms are not specific and occur in other diseases, such as a presumptive diagnosis of pulmonary hypertension is not taken into account from the beginning. Most patients initially complain of breathlessness in terms of physical strain, fatigue and decreased exercise capacity. Subsequently appear piep tightness, extrasystoles and short interruptions (fainting). Along with decreasing the capacity of the heart pumping right, you can reach the water accumulation in the legs (edema).
Diagnosis Presumptive diagnosis of pulmonary hypertension can be placed right on the clinical examination, changes in ECG, chest radiography and echocardiography. Using echocardiography can assess the severity of pulmonary hypertension and heart functionality existing. This test is noninvasive, without risk of radiation and causes no pain patient. The actual values of blood pressure in the pulmonary circulation can be found only by cardiac catheterization, the procedure involves inserting a catheter into the right heart through a small incision in the groin. To determine if pulmonary hypertension was based on other diseases such as pulmonary fibrosis or pulmonary tromboemboila to perform a spirometry (lung functionality testing), a computertomografie and scintigraphy. Your doctor may also recommend certain haematological analysis.
Treatment Advanced pulmonary hypertension result in changes in the three main arteries: - The trend of narrowing (vasoconstriction); - Vascular remodeling and thickening of the lining of small vessels; - Formation of blood clots accented by small vessels (thrombosis in situ); These changes lead to increased pressure in the pulmonary circulation, which in turn leads to right heart failure. The cause is an imbalance between vasodilating substances such as prostacyclin and the vasoconstrictor, endothelin and thromboxane like. Restoring this balance is the target of specific medical treatment.
General Medications In pulmonary arterial hypertension and pulmonary hypertension due to chronic thromboembolism using anticoagulants. In case of right heart failure are given diuretics against edema. Lowering the amount of oxygen in the blood (hypoxia) is controlled by long-term oxygen therapy. Calcium antagonists used most commonly on the treatment of systemic hypertension can also be used to dilate small blood vessels in the circulation. If cardiac catheterization shows a positive reaction to the pulmonary artery vasodilator substances (nitric oxide or iloprost) there is a chance that taking calcium antagonists exclusive to cause a noticeable improvement in symptoms (10% of patients).
Specific Medication The first drug treatment in pulmonary hypertension was synthetic prostacyclin infusion. This treatment is used today in patients at advanced stages, as well as intravenous iloprost. Iloprost is chemically stable so as not to be cool and not lose effectiveness by the decomposition product. By developing more stable forms of prostacyclin have made possible new forms of governance: the inhalation solution in the form of tablets or subcutaneous infusion. Endothelin receptor antagonists such as bosentan, blocks the action of vasoconstrictor Endothelin tissue hormone. Phosphodiesterase inhibitors such as Sildenafil, also acting vasodilator of pulmonary arteries. If a substance tutorials effectiveness is not satisfactory, you can use the simultaneous administration of several drugs (combination therapy).
Surgery If methods of treating pulmonary hypertension drug proves ineffective, it may be used surgical alternative. Septostomia fibrillation is used only when no other treatment does not work. This procedure consists in making a hole in the wall between the two atria for blood to bypass the pulmonary tract. Because this oxygenated blood is critical decrease greatly increases the risk of total concentration in blood oxygen. Another alternative is the lung transplantation surgery and in serious cases the heart and lungs. Endarteriectomia lung is vascular surgery to remove adhesions in patients with pulmonary hypertension due to chronic thromboembolism. Postoperative healing chances are very good.