How to reduce pressure in the pulmonary artery. Treatment and signs of pulmonary hypertension. Manifestations of pathology, classes of the disease

Pulmonary hypertension is a disease whose therapy is difficult due to the undesirable side effect of most antihypertensive drugs - a decrease in systemic arterial pressure. We need drugs that have a more targeted effect - calcium antagonists, endothelin receptor antagonists, prostaglandins and sildenafil.

There is a staged prescription of drugs, especially in the primary and secondary forms of the disease. The low effectiveness of combined treatment is considered an indication for surgery.

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General principles for the treatment of pulmonary hypertension

The method of therapy for all types of pathology is carried out against the background of compliance with recommendations to prevent decompensation of the patient's condition. This requires a special way of life, prevention of infections, prevention of pregnancy, work with a psychologist.

Physical exercise

The level of activity should not exceed the compensatory capabilities of the body, which depend on the stage of pulmonary insufficiency. It is forbidden:

increase the load until dizziness, shortness of breath, fainting, chest pain appear;
exercise after meals, at elevated body or ambient temperature;
stop classes completely, even in severe condition, respiratory and therapeutic exercises are shown.

Pregnancy

The course of pulmonary hypertension is adversely affected by the period of bearing a child, childbirth and the intake of female sex hormones during menopause. Maternal mortality is about 50% with this condition. Therefore, all patients need contraception with drugs that do not contain estrogens (Charosetta, Exluton), barrier methods or surgical sterilization.

When pregnancy occurs, it is necessary to decide on its emergency termination. If women in menopause require replacement therapy, then it is carried out only against the background of anticoagulants and with a particularly severe course of menopause.

flights

The lack of oxygen during air travel causes spasm of the branches of the pulmonary artery, so such patients are recommended:

Drugs for the treatment of pulmonary hypertension

Therapy for high pulmonary pressure includes two directions - supportive (reducing blood viscosity,) and special drugs (and endothelin receptors, prostaglandins, sildenafil).

Anticoagulants and antiplatelet agents

Improving blood flow is indicated in the presence of risk, sedentary lifestyle, hereditary and idiopathic forms of the disease. Apply, and when -. With an increased risk of bleeding, Fraxiparine and. If there are contraindications to anticoagulants, then they switch to the cardiological form of aspirin - Thrombo ACC, Lospirin,.

Diuretic

Improve the condition of patients with overload of the right ventricle. Start with low doses, with inefficiency gradually increase. Recommended:

Lasix,
Uregit,
Trifas,
Inspra,
Veroshpiron.

Oxygen inhalations

Indicated for patients with chronic lung diseases, which are accompanied by bronchial spasm. To control the effectiveness of oxygen therapy, a study of the gas composition of the blood is carried out. It is important not to allow oxygen saturation to fall below 90%.

Maintaining the contractility of the heart

In the presence of circulatory failure, the introduction of Digoxin is indicated to increase cardiac output. Continuous intake of cardiac glycosides is recommended only for atrial tachycardia. In severe situations, Dobutamine is administered to stabilize the pressure in the arterial bed.

calcium antagonists

All vasodilator drugs are needed because of the growth of the muscle layer in the arteries and the increased resistance of the pulmonary vessels to the ejection of blood from the right ventricle. A drug test is used to study the response to vasodilators. Most often, a good effect can be achieved by using such drugs or their analogues:

Corinfar retard,
Diacordin retard,
(Tenox).

With negative results of a drug test, it is not recommended to use such drugs, since the risk of adverse reactions increases - a sharp decrease in pressure, fainting, right ventricular decompensation of blood circulation.

Prostaglandins

This group of medicines has a vasodilating effect, inhibits the hypertrophy of the muscle fibers of the artery wall and the formation of blood clots. The most effective drugs:

Vasaprostan,
Enzaprost,
Ilomedin.

Endothelin receptor antagonists

Bozenex improves exercise tolerance, blood circulation parameters, reduces the functional class of pulmonary hypertension and increases the duration of remission. The second drug is Volibris, it increases the activity of patients, slows down the appearance and growth of signs of pulmonary hypertension. Well tolerated by patients.

Nitric oxide inhalation

This gas relieves vascular spasm, is prescribed in the form of inhalations in stationary conditions. For a similar effect, its predecessor, L-arginine, as well as sildenafil, can be used. The latter connection reduces the load on the heart, inhibits the growth of pressure in the pulmonary artery system. It is used in the form of drugs Revatsio, Viagra.

Prognosis for patients with pulmonary hypertension

The use of new drugs for the treatment of patients with high pulmonary artery pressure has significantly improved the course of this condition. But about one in four patients do not have a positive reaction to medications, even when they are combined. Reduce your chances of success:

negative pharmacological test for vasodilators;
third and fourth functional class;
autoimmune processes;
blockage of the pulmonary veins;
capillary hemangiomas.

The most favorable course of the disease is with congenital anomalies in the structure of the heart. The mortality rate in the first 5 years after the development of pulmonary hypertension is approximately 45%.

Therapy of pulmonary hypertension is based on the prevention of thrombosis, vasospasm and thickening of the muscular layer of the pulmonary arteries. Neighborhoods are used for blood thinning, vasodilators, prostaglandins, endothelin receptor antagonists. Usually, one remedy is chosen for admission, if it is ineffective, they switch to a stronger one or a combination of drugs.

Achieving success is impossible without the prevention of infections, dosed loads, and the exclusion of factors that provoke an exacerbation. The ineffectiveness of therapy is an indication for surgery, including transplantation of the lungs and heart.

Types and classifications

The disease is usually diagnosed only in adults. According to the degree of progression, the following types of hypertension can be distinguished:

First stage. Physical activity in this case is not limited, the disease is almost asymptomatic and is not accompanied by signs of increased pressure. This often makes diagnosis difficult and does not allow early detection of the disease.
Second. Activity is limited due to shortness of breath, weakness and dizziness. In the normal state, these changes are not observed.
Third. In this case, even a slight physical activity can be accompanied by a deterioration in well-being and dizziness.
fourth. Even in a state of complete rest, the patient experiences dizziness, shortness of breath and weakness, as well as pain.

The disease can also be classified according to the types and causes of occurrence:

The choice of method of therapy depends on the degree of development of the disease and on its type according to the classification. She is assigned the ICD-10:I27 code. The methods of therapy are selected on the basis of an accurate diagnosis.

Symptoms and signs of pulmonary hypertension

The main symptom that speaks of pulmonary hypertension is the appearance of shortness of breath. However, it has characteristic features of the disease:

There are other associated symptoms of pulmonary hypertension and its progression:

fast fatigue even with small loads;
chest pains (aching, squeezing, pressing), aggravated by activity and not reduced after taking heart medications;
frequent cough without sputum (rarely may be with blood);
swelling of the limbs;
dizziness, loss of consciousness (may occur during activity);
weakness and apathy;
palpitations.

The presence of many signs of the development of pulmonary hypertension directly depends on the individual characteristics of the patient. All of them are considered in a complex, since they can be characteristics of other serious diseases.

Diagnostics

As a rule, patients come to the hospital with complaints of shortness of breath, pain and fatigue. Doctors in this case pay great attention to the anamnesis and study of the medical history. However, the diagnosis does not end there. For a correct diagnosis, it should be carried out in combination with other procedures:

initial inspection, collection of general information;
examination of the physical condition of the patient, examination of the veins, capillaries and arteries on the body, skin color, detection of the presence of edema of the extremities;
cardiogram, study of the state of the heart in its right section;
ultrasound examination;
echocardiogram, the study of the speed of blood flow and the condition of the capillaries inside the body;
biochemical and general blood test;
computer tomogram and magnetic resonance imaging, study of the pulmonary artery and possible lung diseases;
pressure measurement by catheterization;
chest x-ray.

Thus, the diagnosis is possible only with a multi-stage medical examination of the patient. The reason to see a doctor may be severe shortness of breath, systematic fatigue, pain and swelling of the limbs.

Basic Treatments

Self-medication with increased pressure in the lungs is strictly prohibited, since such a serious disease can lead to serious complications and even death. During therapy, three goals must be achieved:

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The remedy is used at home 30 minutes before meals.

Elimination of the cause of the pathology.
Decreased blood pressure in the lungs.
Prevention of blood clots.

Treatment of pulmonary hypertension is carried out using three main methods: medical, surgical and using traditional medicine.

medical

It is a maintenance therapy using a complex of drugs:

Oxygen therapy is especially effective, which is carried out by taking up to fifteen liters of oxygen. As a rule, drug therapy is carried out at the initial stages of the progression of hypertension.

Surgical

With a serious development of the disease, medication may be ineffective. In this case, surgical intervention is necessary.

Currently, the following methods are most often practiced:

Important: The best prognosis for treatment may be in people who start it in the early stages of hypertension.

Folk remedies

A general improvement in well-being can be expected with the use of traditional medicine recipes as auxiliary. To do this, you can use the following tools:

Pour a tablespoon of ripe rowan berries with a glass of boiling water and leave for fifteen minutes. Take the resulting drink three times a day to reduce swelling and eliminate the state of hypoxia.
Pass a fresh pumpkin through a meat grinder, squeeze out the juice. Take half a glass a day to strengthen the heart muscle and capillary walls, as well as recovery.
Pour a teaspoon of spring adonis with a glass of boiling water and leave for about two hours. Drink one to two tablespoons up to three times a day as a diuretic and pain reliever.

Traditional medicine recipes can only be used as maintenance therapy. It cannot be used as an alternative to a professional one.

Prevention and risk reduction

The following recommendations should be used as preventive and supportive measures:

Vaccination. Necessary for the prevention of viral and catarrhal pathologies, useful in the treatment of autoimmune diseases.
Moderate physical activity and massage. It is necessary to maintain the tone of blood vessels and muscles. However, it is worth paying attention that it should be small and allowed by the doctor.
Proper nutrition. Required to prevent blood clots, obesity and diabetes. Important in the diagnosis of heart failure.
Taking vitamins and minerals to bring their amount back to normal.
Abstinence from hormone therapy.
Status tracking.
Prevention of stressful situations. Depression and systematic stress can negatively affect the nervous and cardiovascular systems. Psychological support, in turn, is important during the treatment period.

When diagnosing a disease or prerequisites for its occurrence, it may be necessary to prevent or terminate a pregnancy, since it increases the risk of serious complications and death during childbirth.

Possible complications of pathology

The last stage of the disease can cause the following complications:

thrombosis;
right ventricular failure;
aggravation of heart failure, chronic insufficiency;
pulmonary edema;
atrial fibrillation;
thromboembolism;
stroke.

The patient may experience systematic blood stasis, swelling of the extremities, pain, changes in blood pressure, which is difficult to restore with drug therapy, swelling of the veins. In such cases, the life span can be significantly reduced, and the extreme degree of complication will be death.

Stroke is the most common complication of hypertension. They represent the greatest danger.

Prognosis and probability of recovery

As a rule, the prognosis for complete relief from pulmonary hypertension is not favorable even with timely diagnosis and treatment. This means that even with high-quality therapy, life expectancy is significantly reduced, and its quality also changes. Statistics indicate the following indicators:

If hypertension develops with scleroderma, with which blood clots take the form of connective tissue, the patient can live no more than a year.
With primary hypertension, the average life expectancy can be about three years.
With lung and heart transplants, the maximum lifespan can be five years.
The development of the disease against the background of dysfunction of the right ventricle of the heart reduces the patient's life to two years.
Medical treatment in the early stages of moderate progression of lung disease helps patients live more than five years.

Thus, the most favorable outcome of therapy and risk reduction largely depend not only on the quality of treatment, but also on the main causes of the onset of the disease and the initial clinical picture.

conclusions

Forms of idiopathic (primary) and secondary pulmonary hypertension can be detected using ultrasound, x-rays, blood tests, and other scientific methods. In this case, it is important to do this as quickly as possible in order to eliminate the cause of the disease and stop it in the early stages. This is the only way to prolong the life of the patient, regardless of the chosen method of treatment.

Do you have any questions? Ask them in the comments! They will be answered by a cardiologist.

Pulmonary hypertension (PH) is a pathological condition characterized by poor health and high blood pressure. The disease without timely intervention gradually progresses and leads to serious disruption and damage to the right ventricle of the heart muscle.

Pathology is characterized by severe symptoms that can lead to death. It is important to detect the disease in time and begin to prevent negative consequences.

What is pulmonary hypertension?

Pulmonary hypertension is a narrowing of the vessels of the lungs, which leads to an overload of the right ventricle of the heart and is manifested by high blood pressure. Most often, the disease is a secondary syndrome due to other disorders in the cardiovascular system. But PH can also be an idiopathic pathology.

ATTENTION! The main hallmark of hypertension is pulmonary arterial pressure above 25 mmHg. Its constant deviation from the norm and the development of pathology leads to disruption and cessation of myocardial functionality, which in a short time can lead to death.

Developing PH is able to influence the state of the entire cardiovascular system, affecting its precapillary (arterioles) and postcapillary (venules) departments, which are responsible for resistance to blood flow in the vessels of internal organs.

The most common primary and secondary types of pulmonary hypertension occur in young women aged 20 to 40 years. The causes of their occurrence and the further development of the disease differ in etiology.

Primary

Pulmonary idiopathic arterial hypertension (Aerz's disease) is a rare disease, in most cases - inherited. A characteristic manifestation of primary PH is a change in the size of the right ventricle and pathological lesions of the pulmonary artery.

The disease progresses rapidly, which puts people who suffer from it at risk of early death. It is possible to prevent it with the timely detection of hypertension, which is characterized by vivid symptoms, as well as with its mandatory treatment.

Secondary

Secondary PH is not a separate type of disease, but a complication of existing diseases, due to which it occurs. Among them:

autoimmune diseases, in particular HIV;
connective tissue diseases;
the presence of VPS ();
diseases and pathologies of the respiratory system;
left ventricular failure.

The manifestation of external and internal signs of hypertension in its secondary form does not differ from idiopathic PH, with the exception of concomitant symptoms of diseases that provoked the development of pathology.

REFERENCE! This type of disease is more common than its primary form, it is curable with timely diagnosis and the cause of the complication.

Classification of the disease according to the nature of the course

Pulmonary hypertension, depending on the complexity and nature of the course of the disease, is classified according to degrees according to the ICD:

1st degree, characterized by the absence of severe symptoms, especially in people suffering. Pathology begins to develop gradually, blood pressure will be slightly increased, while the muscle activity and well-being of the patient remain unchanged.
2nd degree, in which blood pressure increases, the first external signs of pathology appear, manifested after physical activity in the form of shortness of breath, fatigue, and coordination disorders. It is also possible to lose strength with a deterioration in the patient's well-being.
The 3rd degree is distinguished by increased even at rest and with little physical activity. The patient's blood pressure will be significantly elevated even in the presence of hypertension.
The 4th degree, which is the last, is characterized by pronounced symptoms with painful sensations and constant weakness. Blood pressure at this stage of the development of the pathology will be significantly higher than the normal limits, the patient's physical activity will become as difficult as possible.

ATTENTION! It is important not to start the disease to the extreme stage, which in many cases ends in death. The patient needs to monitor blood pressure and well-being.

Causes of the disease

Alexander Bakulev, one of the founders of cardiovascular surgery, and Leo Bokeria, a well-known Soviet cardiac surgeon, studied the characteristics of cardiovascular disease, as well as the definition of the main causes of PH and the treatment measures that depend on them.

The main reasons for the development of PH include chronic diseases and pathological changes in the heart muscle and respiratory system:

obstructive bronchitis;
bronchial asthma and chronic tuberculosis;
bronchiectasis (formation of cavities and suppuration in the lungs);
fibrosis of lung tissue caused by pathological changes in the body;
congenital heart defects, in particular, defects and septa, ventricular and valve defects;
diseases that provoke disruptions in the functioning of the circulatory system and lead to stagnation of blood (, coronary artery disease,);
alveolar hypoxia, which is the most common cause of PH;
defects in the structure of lung tissues;
attacks of hypertension,;
deviations of the blood structure from the norm due to an increased concentration of red blood cells;
HIV infection;
cirrhosis of the liver in an advanced stage;
acquired;
, characterized by increased pressure in the portal vein due to lesions of the liver section;
hyperthyroidism, in which there is an excessive secretion of thyroid hormones;
neoplasms in the chest, its deformation;
compression of the pulmonary vessels due to obesity;
intracranial hypertension arising from pathologies of the brain with concomitant;
left ventricular failure;
disorders of metabolism and metabolic processes in the body.

External factors can also provoke the occurrence of pulmonary hypertension, including:

prolonged use of narcotic drugs, antidepressants and anorexigens;
the impact of toxins and biological poisons when living in places with poor ecology;
especially in women with hypertension;
accommodation and frequent stay in the highlands.

Often, PH occurs as a result of several causes at once in the form of diseases of the cardiovascular and respiratory systems.

Symptoms of the development of PH

At the 1st stage of development, pulmonary hypertension often does not manifest itself, with the exception of a slight increase in blood pressure.

The progression of the disease occurs gradually, its symptoms begin to appear already at the 2nd stage. The clinical picture of PH includes the manifestation of such signs:

Shortness of breath, difficulty breathing at rest, aggravated by physical activity.
Increased heart rate (attacks of tachycardia), resulting from respiratory failure and hypoxia.
Painful sensations of a squeezing nature in the chest.
Fainting states.
Increased fatigue and constant weakness.
Vertigo.
Attacks of suffocation at night.
Swelling of the extremities.
Blueness of the skin.
Pain in the liver, resulting from its pathological increase in volume.
Soreness and heaviness in the right hypochondrium.
Gastrointestinal disorders in the form of nausea, vomiting, bloating and flatulence.
Sudden and rapid weight loss.
Attacks of dry cough with hoarseness.
Coughing fits with expectoration and blood.
Swelling and bulging of the veins in the neck.

IMPORTANT! The manifestation of symptoms occurs with an increase in blood pressure by 2 times or more. , in particular in babies, the symptoms appear more severely and at an accelerated pace, which is why it is important to monitor their health.

Diagnostic measures

To determine pulmonary hypertension, you need to undergo a complete examination in a medical institution. Passage of diagnostics includes the following research methods:

Catheterization of the pulmonary artery, necessary to clarify the blood pressure in it.
Delivery of blood tests (general and biochemical) to determine its composition and comparison with a special code, deviations from which indicate the presence of a malfunction in the body.
Angiopulmonography, during which it is possible to assess the condition of the vessels of the lungs.
CT, the results of which can determine the size of the pulmonary artery and the presence of concomitant diseases and pathologies of the heart muscle and lungs.
A test for determining endurance and exercise tolerance, contributing to the diagnosis and clarification of the stage of development of PH.

Also, to exclude diseases with similar symptoms, differential diagnosis can be carried out using:

coagulograms to determine blood clotting (excluding thrombosis);
Ultrasound of the abdominal organs (exclusion of gastrointestinal diseases);
liver function tests (exclusion of cirrhosis and hepatitis);
HIV test.

Only a full examination allows you to establish the exact disease and determine its stage for the appointment of further treatment.

Methods of treatment

Pulmonary hypertension is treated by a therapist and a cardiologist. Its methods depend on the stage of progression of the pathology, the general condition of the patient and his individual characteristics.

Regardless of the cause of the disease and the degree of its development, the treatment algorithm is as follows:

Identification and elimination of the root cause of the disease.
Decreased blood pressure in the lungs.
Prevention of thrombosis in the arteries.
Symptomatic treatment of the patient.

Comprehensive therapy based on these principles includes:

the use of a course of drugs in the form of tablets and injections;
basic treatment of a patient suffering from PH;
the use of traditional medicine;
surgical intervention in severe stages of pathology.

REFERENCE! Symptomatic therapy may be included in the treatment to eliminate the causes that provoke the development of PH and other pathologies, as well as radiation therapy if a tumor is detected in the lung that has arisen against the background of hypertension.

Medical therapy

The use of drugs is necessary to eliminate the cause of the pathology and alleviate the patient's condition. Mandatory medications include:

Calcium antagonists - to reduce spasm of the vessels of the pulmonary circulation, reduce platelet adhesion and eliminate hypoxia ("Nifedipine", "Verapamil").
Diuretics and diuretics - to remove excess fluid from the body and lower blood pressure ("Lasix", "Veroshpiron").
ACE inhibitors and - to reduce pressure, dilate blood vessels and reduce the load on the heart muscle ("Quadropril", "Lizinopril").
Nitrates - to reduce the load on the heart ("Kardix", "Nitromint").
Antiplatelet agents - to normalize the content and activity of erythrocytes and platelets in the blood ("Clopidogrel", "Iloprost").
Anticoagulants - to prevent thrombosis ("Aspinat", "Dethromb").
Endothelin receptor antagonists - for vasodilatation ("Bosentan", "Sitaxentan").
Vasodilators - to relax the smooth muscle layer of blood vessels ("Nifedipine", "Prazosin").
Bronchodilators - to restore and improve ventilation of the lungs ("Fenoterol", "Berodual").
Antibiotics - to cure bronchopulmonary infections, if any (Azitrox, Fromilid).
Prostaglandins - for enhanced vasodilation and ("Vazaprostan", "Edex").

It is also acceptable to use symptomatic drugs to alleviate the general condition of the patient. Their reception should be prescribed by a doctor in the required amount, depending on the severity of the symptoms.

Basic treatment on an ongoing basis for PH

In addition to taking medication, it is important to adhere to the basic treatment in the presence of pulmonary hypertension. It is based on the following guidelines and requirements:

reducing the amount of fluid consumed to 1.5 liters per day;
reducing the amount of salt consumed;
carrying out oxygen inhalations;
compliance with the dosing of physical activity;
the exclusion of heavy physical exertion, in particular, lifting to a height;
control of mental and emotional state;
giving up bad habits, strong caffeine-containing, as well as tonic and.

IMPORTANT! Exceptionally basic treatment is not able to affect getting rid of PH, but in combination with medical and surgical (if necessary) therapy, it has a positive effect on the patient's health.

Surgical intervention

Severe degrees of development of pulmonary hypertension require surgery. Surgical intervention, depending on the neglect of the pathology, can take place in one of the following forms:

Creation of an artificial opening between the atria of the heart muscle to reduce pressure in the right ventricle.
Lung elimination.
Heart and/or lung transplantation in severe cases of pathology in the presence of irreversible changes and chronic diseases.

Operations in most cases are successful, but require long-term rehabilitation of patients.

ethnoscience

Traditional medicine contributes to the treatment of pulmonary hypertension, strengthens and enhances the effect of mandatory drug therapy. Effective recipes include:

Rowan decoction. Need 1 tbsp. l. berries pour 100 ml of water, boil and let cool. Take the drug should be 0.5 cup three times a day. The decoction helps to normalize blood pressure and strengthen blood vessels.
A decoction of viburnum. It is necessary to pour 20 g of berries into 200 ml of hot water and boil, let the product brew for an hour. It is recommended to use the product 50 ml once a day. It lowers blood pressure and boosts immunity. More effective viburnum recipes are collected in our article:
Garlic. It is necessary to eat 3 cloves 1 time daily to maintain normal pressure and cleanse the venous tract.
Decoction of Adonis. It should be 1 tsp. dried herbs pour 200 ml of boiling water, let it brew for 2 hours. You need to take the remedy for 2 tbsp. l. a day before meals, which will favorably affect the restoration of blood pressure;
Decoction of birch buds. It should be 1 tsp. swollen crushed dry kidneys pour 200 ml of water and boil half in a water bath. Strain the broth and take 1 glass during the day to normalize the pressure.
Melissa infusion. You need 1 tsp. dry leaves pour 250 ml of boiling water and let it brew for 30 minutes. The tool should be squeezed out and taken 1 tbsp. l. three times per day. The infusion can lower blood pressure.

ATTENTION! Traditional medicine is allowed to be taken only after discussion with the doctor!

Possible consequences and complications of the disease

Pulmonary hypertension in the course of its development can lead to negative consequences and complications in the form of chronic diseases and pathologies. These include:

right ventricular failure;
thrombosis of pulmonary arteries, thromboembolism;
hypertensive crises;
pulmonary edema.

Such severe complications without timely therapeutic intervention can lead to further death.

Forecast and prevention

The prognosis of PH disease with timely treatment is most often favorable. In the absence of timely diagnosis and therapy, the prognosis worsens significantly. It is also influenced by the cause of the development of pathology. So, in the absence of concomitant severe and chronic symptoms, the chance of recovery increases significantly, and in the presence of severe diseases of the cardiovascular system, on the contrary, the risk of death increases.

To avoid the development of pulmonary hypertension, it is recommended to follow simple preventive rules:

lead a healthy and active lifestyle;
give up bad habits in the form of smoking and alcohol abuse;
do not delay the treatment of infectious diseases;
observe the measure during physical activity;
avoid stressful situations, emotional outbursts.

Conclusion

Pulmonary hypertension can be fatal. Severe symptoms of the disease require immediate treatment to the clinic for diagnosis and therapy. It is important to monitor your health, maintain a healthy lifestyle and visit doctors regularly to prevent the development of hypertension, its progression and the occurrence of complications.

Pulmonary hypertension is a dangerous and progressive condition in which there is a persistent increase in pressure in the vascular bed of the pulmonary artery. Only in 6-10% of cases this pathological condition can be idiopathic (or primary) and occur due to genetic mutations or other causes. In the rest of the patients, pulmonary hypertension is secondary, and its development is due to the complicated course of various diseases.

Normally, at rest, the average pressure in the pulmonary artery is 9-15 mm Hg. Art. To make a diagnosis of "pulmonary hypertension", specialists are guided by the following criteria: an increase in pressure above 25 mm Hg. Art. at rest or more than 50 mm Hg. Art. under load.

In this pathological condition, the pressure in the pulmonary artery increases gradually and progressively. Ultimately, pulmonary hypertension causes right ventricular failure, which can subsequently lead to death. According to statistics, this pathological condition is 4 times more common in women than in men. The average age of patients is usually from 30 to 40 years, but an increase in pressure in the vessels of the lungs can be detected in both childhood and old age.

In this article, we will introduce you to the main causes, manifestations, ways to identify and treat pulmonary hypertension. This information will help you suspect the development of the disease in time, and you will make the right decision about the need to see a doctor.

Pulmonary hypertension in most cases develops secondary to other heart diseases.

So far, scientists have not been able to establish the causes of the development of such a rare disease as idiopathic pulmonary hypertension. It is assumed that its occurrence can be caused by gene mutations, autoimmune diseases or oral contraceptives.

Secondary pulmonary hypertension is a pathological condition that can provoke various chronic diseases of the lungs, blood vessels, heart and some other systems and organs. Most often, this complication is provoked by the following ailments:

and ( , defects of partitions, etc.);
diseases accompanied by;
neoplasms of the lungs and heart;
chronic inflammatory and obstructive processes in the lungs and bronchi (tuberculosis, pneumosclerosis, emphysema, sarcoidosis);
vasculitis with localization in the area of the pulmonary artery;
pulmonary-hepatic vascular pathologies and late stages of liver dysfunction;
violations of the structure of the chest and spinal column (kyphoscoliosis, ankylosing spondylitis, Pickwick's syndrome in obesity, errors in thoracoplasty);
blood pathologies: chronic hemolytic anemia, myeloproliferative diseases, condition after splenectomy.

In addition, pulmonary hypertension can be provoked by a number of acute diseases and conditions:

respiratory distress syndrome, caused by an autoimmune or toxic lesion and leading to an insufficient amount of surfactant on the lung tissue lobules;
severe diffuse pneumonitis, accompanied by a severe allergic reaction to inhaled odors of perfumes, paints, flowers, etc .;
taking certain medications and exposure to toxins (toxic rapeseed oil, Aminorex, amphetamines, Fenfluramine, L-tryptophan, cocaine, cytostatics, etc.);
taking traditional medicine or food products.

Statistical data point to the fact that HIV-infected people, drug addicts, people taking appetite suppressant drugs, patients with arterial hypertension and pregnant women are most prone to developing pulmonary hypertension.

Pulmonary hypertension in newborns can be caused by the following conditions:

general hypoxia;
diaphragmatic hernia;
meconium aspiration;
sustained fetal circulation.

Development mechanism

The development of pulmonary hypertension is provoked by a gradual narrowing of the lumen of the vessels of the pulmonary artery bed - capillaries and arterioles. Such changes are caused by a thickening of the inner layer of blood vessels - the endothelium. In a complicated course, such a process may be accompanied by inflammation and destruction of the muscular layer of the pulmonary artery.

The narrowing of the lumen of the vessels causes a constant settling of blood clots in it and leads to its obliteration. Subsequently, the patient increases the pressure in the pulmonary artery system and develops pulmonary hypertension. This process increases the load on the right ventricle of the heart. Initially, its walls hypertrophy, trying to compensate for the violation of hemodynamics. Subsequently, due to constant loads, their contractility decreases and the stage of decompensation develops, which is expressed in right ventricular failure.

Classification of pulmonary hypertension by class

Depending on the severity of the symptoms and the severity of the patient's condition, four classes of pulmonary hypertension are distinguished:

I - the physical activity of the patient does not suffer, after the usual loads he does not develop dizziness, weakness, shortness of breath and chest pain;
II - the physical activity of the patient is slightly disturbed, at rest the state of health does not change in any way, but after the usual loads, he develops dizziness, weakness, shortness of breath and chest pain;
III - the physical activity of the patient is significantly impaired, even minor physical exertion causes dizziness, weakness, shortness of breath and chest pain;
IV - even minimal exercise causes dizziness, weakness, shortness of breath and chest pain, often the same symptoms occur at rest.

Symptoms

At first glance, unexplained, unrelated shortness of breath may be a manifestation of pulmonary hypertension

The main insidiousness of pulmonary hypertension is that during the compensation stage it can be completely asymptomatic and is already detected in advanced forms. Its first signs begin to appear only when the pulmonary arterial pressure exceeds the norm by 2 times or more.

Usually the first symptoms of pulmonary hypertension are:

the appearance of inexplicable shortness of breath even with minor exertion or at complete rest;
unexplained weight loss with the usual diet;
hoarse voice;
episodes of dizziness or fainting;
cardiopalmus;
noticeable pulsation of the jugular vein in the neck;
feeling of discomfort and heaviness in the liver.

Later, the patient appears and. In addition, streaks of blood may be detected in the sputum. With increasing pulmonary edema, the patient develops hemoptysis.

The patient complains of pain in the right hypochondrium, which is provoked by the development of venous congestion. When probing the abdomen, the doctor determines the expansion of the boundaries of the liver and pain. Violations of hemodynamics in the systemic circulation lead to the appearance of edema in the legs (in the area of the feet and legs) and accumulation of fluid in the abdominal cavity (ascites).

At the terminal stage of the development of pulmonary hypertension, hypertensive crises occur in the vascular bed, provoking the development of pulmonary edema. They begin with attacks of lack of air, then the patient begins to cough violently with the release of bloody sputum, fear and anxiety appear. The skin becomes cyanotic, the patient develops psychomotor agitation, feces can be uncontrollably separated and light urine is abundantly excreted. In severe cases, pulmonary edema ends with the development of acute heart failure and pulmonary embolism, which are fatal.

Diagnostics

The most common complaint of patients with pulmonary hypertension, with which they come to the doctor's office, is shortness of breath. When examining the patient, cyanosis is revealed, and when listening to heart sounds, splitting of the II tone in the projection of the pulmonary artery and its accent.

To clarify the diagnosis of pulmonary hypertension and obtain a complete clinical picture, the following types of studies are prescribed:

radiography of the lungs;
functional breathing tests;
qualitative and quantitative analysis of blood gases;
catheterization of the "right" heart and pulmonary artery;
angiopulmonography;
scintigraphy.

Treatment

Treatment of pulmonary hypertension should always begin as early as possible and be comprehensive. It includes recommendations to reduce the risk of aggravation and complications of the pathological condition, treatment of the underlying disease and symptomatic drug therapy. As a supplement, folk or non-traditional methods can be used. With the ineffectiveness of conservative therapy, the patient is recommended surgical treatment.

To reduce the existing risks of pulmonary hypertension, patients are recommended to:

vaccination against influenza and pneumococcal infections, which aggravate the course of the pathology;
regular and dosed physical activity;
following a diet for heart failure;
prevention of pregnancy.

Relatives and relatives of patients with pulmonary hypertension should provide them with constant psychological support. These patients often develop depression, feel unwanted, often get irritated over trifles, and do not want to be a burden to their environment. Such a dejected state negatively affects the course of pulmonary hypertension, and constant psychological work on the existing problem is necessary to eliminate it. If necessary, patients may be advised to consult a psychotherapist.

Medical therapy

Drug treatment includes a number of drugs that act on the cause or pathogenesis of the disease, alleviating a particular symptom.

To eliminate the manifestations and consequences of pulmonary hypertension, the patient is prescribed the following groups of drugs:

– reduce the load on the heart, reduce swelling;
and - reduce the load on the heart, prevent the development of thrombosis and thromboembolism;
- improve heart function, eliminate arrhythmias and vascular spasms, reduce shortness of breath and swelling;
vasodilators - reduce pressure in the pulmonary bed;
prostacyclins and endothelin receptor antagonists - block the growth of the endothelium, eliminate vascular and bronchial spasm, and prevent thrombosis.

To eliminate hypoxia in severe patients, courses of oxygen therapy are indicated.

In idiopathic pulmonary hypertension, patients are prescribed type 5 PDE inhibitors (Sildenafil) and nitric oxide. Their action provides a decrease in vascular resistance, eliminates hypertension and facilitates blood flow.

ethnoscience

As additional means for the treatment of pulmonary hypertension, the doctor may recommend taking herbs:

infusion of red rowan fruits;
freshly squeezed pumpkin juice;
infusion of spring adonis, etc.

Patients with pulmonary hypertension should be aware that the treatment of this pathology is impossible only with the help of folk remedies. Medicinal herbs in such cases can only be used in the form of mild diuretics and fees to calm the cough.

Surgery

To facilitate the work of the heart, the patient may be recommended to perform a balloon atrial septostomy. The essence of this intervention is the introduction of a catheter with a balloon and a blade into the left atrium, which cuts the septum between the atria. Using a balloon, the doctor expands the incision and thus facilitates the discharge of oxygenated blood from the left half of the heart to the right.

In extremely severe cases, lung and/or heart transplants may be performed. Such interventions are performed in specialized surgical centers and are often unavailable due to the scarcity and high cost of donor organs. In some cases, transplantation may be absolutely contraindicated: malignant neoplasms, HIV infection, smoking, the presence of HBs antigen, hepatitis C, and drug or alcohol use in the last 6 months.

Forecasts

In secondary pulmonary hypertension, the prognosis is favorable if the rate of development of the pathological condition remains low, the prescribed therapy is effective and leads to a decrease in pressure in the pulmonary bed. With the rapid progression of symptoms, an increase in pressure of more than 50 mm Hg. Art. and poor treatment efficacy, the prognosis worsens. In such cases, most of the patients die within 5 years.

Idiopathic pulmonary hypertension always has a very poor prognosis. During the first year of the disease, only 68% of patients remain alive, after 3 - 38%, and after 5 years - only 35%.

Pulmonary hypertension refers to severe and dangerous pathological conditions that, over time, can cause the death of a patient from pulmonary embolism or ever-increasing right ventricular heart failure. Her treatment should begin as early as possible, and the patient needs constant monitoring by a pulmonologist and a cardiologist.

The first channel, the program "Live is great!" with Elena Malysheva, in the section "About medicine" a conversation about pulmonary hypertension (see from 34:20 min.):

Scientific report by Tsareva N.A. on the topic "New in the treatment of pulmonary hypertension":

MD Konopleva L.F. talks about the treatment of pulmonary hypertension:

A pathological condition, the course of which is characterized by an increase in pressure in the pulmonary artery, is called pulmonary hypertension in medicine. In terms of frequency, the disease ranks third worldwide among vascular diseases characteristic of the elderly.

Causes of Pulmonary Hypertension

Pulmonary hypertension can be either a congenital anomaly, that is, primary, or acquired, which is called secondary.

The following factors may be the reason for the increase in pressure in the arteries of the lungs:

heart failure;
vasculitis;
heart defects of various origins;
chronic lung diseases, including tuberculosis, bronchial asthma, etc.;
PE or other lesions of the pulmonary vessels;
metabolic disorders;
location in high mountain regions.

In cases where it is not possible to determine the exact causes of hypertension, the doctor makes the diagnosis of primary hypertension. As a disease state of unknown origin, primary pulmonary hypertension can be triggered by various contraceptives or result from an autoimmune disease.

Secondary pulmonary disease can be caused by pathologies of the heart muscle, lungs or blood vessels.

Disease classification

Depending on the severity of the course of the disease state, physicians distinguish 4 classes of patients:

The first stage, not accompanied by loss of physical activity. A patient with pulmonary insufficiency can withstand normal activities without the appearance of weakness, dizziness, chest pain or shortness of breath.
At the second stage disease, the patient's physical activity is limited. At rest, there are no complaints, but the usual load causes severe shortness of breath, dizziness and severe weakness.
Third stage of hypertension causes the above symptoms with the slightest physical activity of a person suffering from this disease.
Pulmonary hypertension stage IV marked by pronounced signs of weakness, shortness of breath and pain, even when a person is in a state of absolute rest.

Symptoms of lung failure

The main symptom of the disease is shortness of breath, which has several specific features that make it possible to distinguish it from the symptoms of other diseases:

schematic structure of the vessels of the lungs

observed at rest;
its intensity increases with minimal physical activity;
in a sitting position, shortness of breath does not stop, unlike shortness of breath of cardiac origin.

Other signs of pulmonary hypertension are also characteristic of most patients:

weakness and fatigue;
persistent dry cough;
swelling of the legs;
pain in the liver area caused by its enlargement;
pain in the sternum due to the fact that the pulmonary artery expands;
in some cases, a hoarse voice is observed. This is due to the fact that the artery, when expanded, infringes on the laryngeal nerve.

Thus, pulmonary hypertension, the symptoms of which are often not specific, does not always allow a correct diagnosis to be made without a whole range of examinations.

Diagnosis of the disease

As a rule, patients come to doctors with complaints of severe shortness of breath, which interferes with their daily life. Since primary pulmonary hypertension does not have specific symptoms that allow a diagnosis to be made with confidence at the first visit to the doctor, the diagnosis should be carried out with the participation of a cardiologist and pulmonologist.

The complex of procedures involved in the process of making a diagnosis includes the following methods:

medical examination and history taking. Often the disease has hereditary causes, so it is extremely important to collect information about family ailments;
clarification of the current lifestyle of the patient. Smoking, refraining from physical activity, taking various medications - all this is important in finding out the causes of shortness of breath;
general inspection. On it, the doctor has the opportunity to identify the physical condition of the veins in the neck, skin color (blue in case of hypertension), enlargement of the liver, the occurrence of edema in the legs, thickening of the fingers;
electrocardiogram. The procedure allows you to identify changes in the right side of the heart;
echocardiography helps to determine the rate of passage of blood and the general condition of the vessels;
will show, using a layered image, an increase in the pulmonary artery, as well as possible concomitant ailments of the lungs and heart;
radiography of the lungs will allow you to observe the condition of the artery, its expansion and narrowing;
the catheterization method is used to reliably measure the pressure inside the pulmonary artery. Doctors consider this procedure not only the most informative for obtaining pressure values, but also associated with minimal risks of complications;
the 6-minute walk test helps determine the patient's physical response to stress and establish the class of hypertension;
blood test: biochemical and general;
angiopulmonography allows, by introducing a special contrast agent into the vessels, to obtain a complete picture of the vessels in the region of the pulmonary artery. The method must be used with extreme caution, since its use can provoke a hypertensive crisis in the patient.

Thus, pulmonary hypertension should be diagnosed only after a thorough comprehensive study of the patient's vascular condition in order to exclude an erroneous diagnosis.

Reason to see a doctor

The patient should consult a doctor if he feels the following signs of malaise:

the occurrence or increase in shortness of breath when performing normal daily activities;
the appearance of pain of undiagnosed origin in the chest;
if the patient has an inexplicable and persistent feeling of fatigue;
the appearance or increase in the degree of swelling.

Treatment of pulmonary insufficiency

In most cases, primary pulmonary hypertension is treatable. The main guidelines for choosing a treatment method are:

identification and elimination of the cause of the patient's condition;
decrease in pressure in the artery of the lung;
preventing the formation of blood clots in the patient's vascular system.

When prescribing treatment, the doctor may prescribe the following drugs:

medicines that act relaxing on the muscular layer of blood vessels. This group of drugs is very effective in the initial stages of the disease. Pulmonary hypertension, the treatment of which was started even before the vascular changes become pronounced and irreversible, has a very good chance of completely getting rid of the patient's symptoms;
medicines designed to lower the viscosity of the blood. If the blood clotting is very severe, the doctor may decide to bleed. The hemoglobin level in such patients should not exceed 170 g/l;
with severe shortness of breath and hypoxia, oxygen inhalations are indicated as a means of relieving unpleasant physiological symptoms;
Your doctor may recommend reducing your salt intake and reducing your fluid intake to 1.5 liters of clean water per day.
a strict ban on intense physical activity. Only such activity is allowed in which the patient does not feel discomfort and painful manifestations;
if pulmonary hypertension is accompanied by a complication in the form of insufficiency of the right ventricle of the heart, the doctor prescribes regular intake of diuretic drugs;
in the most advanced cases of the disease, they resort to a heart and lung transplant procedure. The technique has not yet been sufficiently developed in practical conditions, but the statistics of such transplantations testify to their effectiveness.

Possible Complications

Among the negative consequences of the disease, the main ones can be distinguished:

exacerbation of heart failure. The right parts of the heart can no longer cope with their current load, which further worsens the patient's situation;
a condition called PE is a thrombosis of an artery in the lung when a blood clot blocks a vessel. This disease is not only dangerous, but directly threatens the life of the patient;
associated with pulmonary edema.

As a rule, the disease significantly reduces the patient's standard of living and in most cases leads to premature death.

At the same time, pulmonary hypertension causes chronic or acute forms of heart and lung failure, life-threatening for the patient.

Prevention

In order to minimize the risk of this disease, the following measures must be taken:

adhere to the principles of a healthy lifestyle. In particular, it is necessary to categorically give up smoking and do physical exercises daily;
it is necessary to timely identify and treat the underlying diseases that entail hypertension. This is possible in the case of regular preventive visits to the doctor;
with established diseases of the bronchi and lungs of a chronic nature, you need to carefully monitor the course of the disease. Dispensary observation will avoid complications of the disease and facilitate its course;
diagnosed pulmonary hypertension is not a ban on any physical activity. On the contrary, such patients are shown a moderate exercise in the fresh air. Activity should be regular, but never more intense;
all situations that entail a stressful state must be excluded. Conflicts at work, at home or in transport can exacerbate the disease.

Thus, the sooner the patient turns to the doctor for advice and the more carefully he follows his instructions, the more likely it is to stop the course of the disease and not transfer it to a more severe stage that is less treatable.