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What is it about ?
Pulmonary hypertension is a disease defined by too much pressure in the blood vessels of the lungs. Usually, it is caused by a narrowing of these blood vessels. The right ventricle therefore has to pump harder to send blood to the lungs, which causes the right ventricle to dilate. However, this only compensates to a limited extent. At a certain point, the heart will simply pump less blood to the lungs. The amount of oxygen entering the general circulation will decrease. This causes typical symptoms, such as shortness of breath to the effort.
Many diseases can increase blood pressure in the lungs:
- In pulmonary arterial hypertension (PAH), the arteries in the lungs are narrowed. This may not have an obvious cause or may be due to a hereditary predisposition, certain connective tissue diseases, congenital heart disease, liver cirrhosis, at theHIV infection or the use of certain diet pills or the consumption of drugs;
- Chronic thromboembolic pulmonary hypertension (HTP-TEC) can be a complication ofpulmonary embolism ;
- Several diseases can also cause, via various mechanisms, pulmonary hypertension, for example leukemia, systemic diseases, thyroid disorders …, as well as the removal of the spleen.
- The increased pressure in the veins can also be the result of heart failure (left) and problems with the valves of the heart;
- Pulmonary diseases (for example COPD) and situations which go hand in hand with a chronic lack of oxygen (for example sleep apnea syndrome, prolonged stay at high altitude) can lead to increased pressure in the lungs.
These last two causes of pulmonary hypertension are the most common. Pulmonary arterial hypertension is therefore usually the expression of an underlying heart or lung disease.
What is its frequency?
Pulmonary hypertension is rare. In Belgium, around 400 people have it.
How to recognize it?
The two main symptoms are shortness of breath (during exertion or at rest) and limitation during exertion. May also be present: fatigue, chest pain, palpitations, cough, hoarseness, stomach ache, swollen stomach, swollen veins in the neck and accumulation of fluid in the legs (edema). Short episodes of unconsciousness are possible.
How is the diagnosis made?
During the clinical examination, the doctor looks for possible cardiac and pulmonary abnormalities. Changes in heart function can usually be seen on the electrocardiogram (ECG, recording of heart activity).
If pulmonary hypertension is suspected, you will be sent to the hospital. The diagnosis is confirmed by ultrasound of the heart (echocardiography). In some cases, cardiac catheterization is performed. During this exam, the doctor inserts a catheter (a thin tube) through the groin or the wrist. The pressure in the heart is then measured directly.
The basic examination also includes an x-ray and / or a CT scan of the lungs. Any underlying diseases can thus be detected.
What can you do ?
There is nothing you can do to prevent illness. If you have any symptoms, it is best to contact your doctor.
If you’ve been diagnosed with pulmonary hypertension, be careful with certain medications. You should avoid certain medications (nasal drops and amphetamine derivatives such as Rilatin®) which further narrow the blood vessels. Always discuss this with your doctor.
Just as important is getting enough exercise and watching your weight. If you smoke, try to quit.
What can the doctor do?
Treatment is determined individually depending on the severity, the presence of other diseases and the drugs already used. Treatment usually involves the administration of oxygen, blood thinners, diuretics, vasodilators, and drugs that support heart function. This treatment relieves symptoms, but does not provide a cure.
Surgery may be attempted to remove blood clots that are blocking the pulmonary arteries. Making an opening between the right atrium and the left atrium can relieve the strain. In exceptional cases, a lung transplant is necessary.
Sources
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