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Pulmonary Hypertension

Medical Reviewing Editor: William C. Shiel, Jr., MD, FACP, FACR

What is pulmonary hypertension?

The human body has two major areas of blood vessels that distribute from, and return blood to, the left and right heart. The portion of the circulation that distributes the blood from the left side of the heart, throughout the body, is referred to as the systemic circulation. The portion of the circulation that distributes the blood from the right side of the heart, to the lungs, is referred to as the pulmonary (lung) circulation.

The left ventricle of the heart pumps oxygenated blood from the lungs into the systemic circulation. When a doctor or a nurse measures the blood pressure on a person's arm, he/she is measuring the pressures in the systemic circulation. When these pressures are abnormally high, the person is diagnosed as having high blood pressure (hypertension).

The right ventricle pumps venous blood returning from the body into the arteries of the lungs to receive oxygen. The pressures in the lung arteries (pulmonary arteries) are normally significantly lower than the pressures in the systemic circulation. When pressure in the pulmonary circulation becomes abnormally elevated, it is referred to as pulmonary hypertension.

What causes pulmonary hypertension?

Pulmonary hypertension results from constriction, or tightening, of the blood vessels that supply blood to the lungs. Consequently, it becomes difficult for blood to pass through the lungs, making it harder for the heart to pump blood forward. This stress on the heart leads to enlargement of the heart and eventually fluid can build up in the liver and tissues, such as the in the legs. Affected patients can sometimes notice increasing shortness of breath and dizziness.

Pulmonary hypertension can be caused by diseases of the heart and the lungs, such as chronic obstructive pulmonary disease (COPD) or emphysema, failure of the left heart ventricle, recurrent pulmonary embolism (blood clots traveling from the legs or pelvic veins obstructing the pulmonary arteries), or underlying diseases such as scleroderma. Pulmonary hypertension can also be caused by chronic low blood oxygen levels as in some patients with sleep apnea. Pulmonary hypertension caused by other illnesses is called secondary pulmonary hypertension.

When pulmonary hypertension occurs without underlying heart and lung disease or other illnesses, it is called primary pulmonary hypertension. Primary pulmonary hypertension is more common in young females. Recently this condition has been rarely reported with the use of anti-obesity drugs such as Redux and Fen/Phen.

Tests used to evaluate patients with suspected pulmonary hypertension include chest x-ray and high-resolution CAT scanning, pulmonary function tests, and echocardiogram. Right heart catheterization (angiogram) can be used to confirm the diagnosis.



Next: What is the treatment for pulmonary hypertension? »



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Last Editorial Review: 9/6/2006





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