Pulmonary Hypertension Is the increase in blood pressure in the pulmonary artery above 25 mmHg at rest and more than 30 mmHg with exercise.
The pulmonary circulation distributes blood from the heart to the lungs through a low resistance and high compliance. In normal situation, the pressures are lower than in the systemic circulation .
You can be a primary process (primary pulmonary hypertension) or appear within other diseases, respiratory or not, then called secondary pulmonary hypertension.
Primary pulmonary hypertension:
Pulmonary hypertension is of unknown cause, characterized by alteration of small muscular arteries of the lung, observing pathological changes in the pulmonary arterioles features. Predominantly affects females and the highest incidence is between the 3rd and 4th decade of life.
Secondary pulmonary hypertension:
Due to various diseases, among which Chronic Obstructive Pulmonary Disease (COPD) and pulmonary embolism (PE).
In both situations there is an increased resistance of the pulmonary circulation with consequent sobresfuerzo the heart to maintain blood flow. In this case held overexertion right heart secondary to pulmonary hypertension is known as cor pulmonale.
The most common clinical signs of respiratory distress that is often characterized as being of effort and progressive, especially in cases of primary pulmonary hypertension and COPD. Likewise also seen asthenia andsyncope with exercise.
Clinical manifestations of PTSD are totally nonspecific. The most common symptoms are dyspnea (usually occur acutely) and chest pain that is often pleuritic, but there are cases with major arterial occlusion degrees with little or even no symptoms.
In cor pulmonale, the predominant symptom is the underlying disease itself. In cases of right heart failure signs can appear as the lower extremity edema, jugular venous distention , hepatomegaly (enlarged liver) and cyanosis.
Additional tests in the case of pulmonary hypertension tend to be very specific. Blood tests are usually normal and cardiac studies by electrocardiogram and echocardiography showed hypertrophy and right ventricular overload.
The diagnosis is based on angiography after catheterization the pulmonary circuit, after ruling out other respiratory diseases, such as cardiovascular and systemic causes of the clinical picture, but keep in mind that these are high-risk exploration and indications should be individualized.
In PTSD, additional tests are also nonspecific, being mostly useful to rule out other similar symptoms (pneumonia, pneumothorax, myocardial infarction, among others). Diagnosis of pulmonary arterial occlusion takes place with the ventilation / perfusion. Together with the results of chest radiography universal criteria have been developed for high, medium and low probability of PE and avoid the use of angiography is the definitive diagnostic test but high risk. Its use is reserved only for doubtful cases or situations of high urgency.
The most effective treatment is the treatment of the underlying disease can in some cases reduce lung pressure by correcting the primary cause.
However, in the case of primary pulmonary hypertension, treatment is limited. Naturally, the disease causes a progressive deterioration with an average life span from onset of symptoms for about 5 years, however, there are cases with changes over 20 years.
Supportive measures consist of oxygen therapy in patients with hipoxemi to and diuretics in cases of fluid overload.
Vasodilator therapy is useful in some cases but it is not possible to anticipate which patients will respond to treatment. Stresses the epoprenostol (prostacyclin) intravenous, intravenous adenosine, calcium orally or inhaled nitric oxide. In patients responding to these drugs, improve their symptoms and may even prolong survival.
Anticoagulation is usually indicated in most of the patients suffering from primary pulmonary hypertension, because of increased risk of thrombosis and limited physical activity.
The last resort is therapeutic lung transplantation of one or both lungs, even with reduced cardiac function.
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