Pulmonary Hypertension (cont.)
What are the signs and symptoms of pulmonary hypertension?
Many people with pulmonary hypertension may have no symptoms at all,
especially if the disease is mild or in early stages.
Pulmonary hypertension symptoms may include:
- The most common symptoms of pulmonary hypertension is
shortness of breath
that worsens with activity.
- Other common complaints are
cough,
fatigue,
dizziness, and
lethargy.
- With the
advancement of the condition and ensuing right
heart failure, shortness of
breath may get worse and retention of fluid in the body may increase (due to
failure of the heart to pump blood forward) resulting in swelling the legs.
- People may also complain of
chest pain and
angina.
Signs of pulmonary hypertension may include:
- A rapid
breathing, hypoxia (low
oxygen level in the blood), and swelling in the legs.
- In severe pulmonary
hypertension, the doctor may hear louder than normal components of heart sounds
when he or she listens to the heart with a
stethoscope
(auscultation).
- The doctor may also feel elevation of the chest wall when the
heart pumps and this may indicate enlargement of the right side of the heart
suggestive of pulmonary hypertension (right ventricular heave).
How is pulmonary hypertension diagnosed?
The first step in diagnosis of pulmonary hypertension is to clinically
suspect it. This may be done as part of an evaluation of another disease that
can lead to pulmonary hypertension (such as scleroderma or chronic obstructive
pulmonary disease) or based on patients and signs and symptoms as described
above.
Many tests, such as echocardiogram, may be performed that be give us clues to
the possibility of pulmonary hypertension. But the gold standard (the best test
available) is right heart catheterization. This test entails inserting a
catheter through the groin into the femoral vein, a large
vein in the lower body (or under the collar bone or in the upper arm into the
subclavian vein, a large
vein in the upper body) and advancing it to the right side of the heart. The
catheter is connected to a device that can monitor and measure blood pressure in
the right side of the heart and pulmonary arteries.
During right heart catheterization, response to certain
medication to treat pulmonary hypertension can be assessed. This is done by
administering medications for pulmonary hypertension while the patients still
has the catheter placed in heart. Then pulmonary blood pressure is monitored and
the response to treatment is compared to no treatment. This can give the
physicians a clue as to if an individual is a candidate for a certain therapy
and also what dosage of
the medicine may be appropriate.
Pulmonary hypertension is defined as the mean pulmonary artery blood pressure
greater than 25 millimeter of mercury (mmHg) measured by right heart
catheterization. The pressures can be much higher than 25 mmHg in some people.
Therefore, the pulmonary hypertension can be labeled as mild, moderate, or
severe based on the pressures. Mean arterial pressure is two-thirds of the
difference between systolic and diastolic blood pressure (systolic is the upper
number and diastolic is the lower number in measuring blood pressure). As
explained above, the pulmonary blood pressure is much lower than the systemic
blood pressure.
What tests other than right heart catheterization may be used in diagnosing pulmonary hypertension?
Other tests available for diagnosing pulmonary
hypertension include electrocardiogram (ECG), chest x-ray, and echocardiogram.
An ECG may show some abnormalities that may be suggestive of right heart
failure. Chest x-ray may also show enlargement of the chambers of the right
heart. And echocardiogram (ultrasound of the heart) shows ultrasound images of the heart and can detect
evidence of right heart failure and pressures in the pulmonary artery can be
estimated. These tests, in the right clinical setting, are very useful in
diagnosing pulmonary hypertension.
Other tests may be useful in evaluating the conditions
leading to secondary pulmonary hypertension. For example, a
ventilation-perfusion scan (V/Q scan) can
detect blood clots in the pulmonary arteries suggesting chronic thromboembolic
pulmonary hypertension. A pulmonary function test can be useful in diagnosing
chronic obstructive pulmonary disease (COPD).
Next: What is the treatment for pulmonary hypertension? »
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