“Tips” in pulmonary hypertension

2023-05-12 10:36:02

“Pulmonary hypertension, which is a relatively frequent pathology because it is usually secondary to other heart and lung diseases, such as COPD, occurs when high blood flow pressure affects the arteries of the lungs and the right side of the heart,” he indicates. Dr. Carlos Macaya Miguel

Heart News: “Tips” on pulmonary hypertension

From the Interhospital Foundation for Cardiovascular Research (FIC), Dr. Macaya reminds us that “oxygenated blood, rich in nutrients, reaches the last cell of the human body thanks to the arteries and then returns without oxygen to the heart to be revitalized through the veins.”

This circulatory process, major and minor, is incessant; and the blood flow is achieved with the systole or contraction and diastole or dilation of the heart muscle.

For this reason, although we only have one heart, it is divided into two halves, which are even called ‘right heart’ and ‘left heart’.

The four valves of the heart, tricuspid, pulmonary, mitral, and aorticalmost transparent connective tissue veils, give way to blood through the atria and ventricles.

They are responsible for ensuring that the blood flow that reaches the heart does not go backwards, but instead flows forward with each beat, opening some and closing others in a rhythmic and coordinated manner.

“The pulmonary artery originates in the right ventricle of the heart and leads to the lungs, through the pulmonary valve, all the venous blood for oxygenation. Next, the oxygenated blood goes to the left side of the heart, ”he describes.

“This part of the vascular circuit is of low pressure, with an average of the order of 20 mmHg; that if we compare it with the blood pressure normal (120 mmHg systolic/80 mmHg diastolic) we are talking about a fifth of the blood pressure that we all know”, he completes.

But sometimes, the pressure in the pulmonary artery increases and then hypertension occurs.

“Almost always due to a problem originating in the lungs, such as chronic obstructive pulmonary disease (COPD), due to heart disease or a primary pathology in the artery itself”, frames Dr. Carlos Macaya, interventional cardiologist.

Flies pen notes of pulmonary hypertension

This arterial injury, which occurs for unknown causes, damages the smooth muscle of the blood vessel, which contracts and narrows; which hinders blood flow and puts the ventricle on the right side of the heart in a bind, which will increase in size.

This overwork of the heart muscle generates a gradual weakening of the ventricle that culminates in low functional performance; that is, oxygen-depleted blood is pumped with difficulty to the lungs. As a consequence, heart failure occurs on the right side of the heart.

This diseased process of the pulmonary artery, without being very prevalent, occurs in people of any age, although it affects more young adults, especially women, who are twice as affected as men.

And where are its pathological origins?

This arterial disease results, from added clinical experience, from other major organic ailments, such as certain lung diseases (fibrosis, emphysema, bronchitis and epoch -smoking or not-), rheumatic (lupus and scleroderma) or liver (cirrhosis and chronic liver disease).

Also of cardiovascular diseases: problems of the aorta and mitral valves, heart failure of the ventricle on the left side of the heart and congenital diseases.

“It is like a fish that bites its tail, since the pulmonary artery crisis, affected by the lungs in decline, causes revolts in the circulatory and functional systems of the heart muscle; which in turn weakens the arterial walls of the pulmonary vessels with a higher pressure”, portrays Dr. Macaya.

In addition, pulmonary hypertension can be caused by sleep apnea, living at high altitudes, and from kidney disease, tumors, inflammatory and blood disorders, coagulation disorders, and chronic clots in the lungs.

In addition, a pathology characteristic of the artery interacts, without secondary actors.

“We talk about PAH (pulmonary arterial hypertension) due to a progressive increase in pulmonary vascular resistance as a consequence of vasoconstriction, wall obstruction, inflammatory reaction or thrombus formation in the pulmonary arterioles”, he explains.

“Fortunately, PAH affects a very small group of people (between 15 and 20 per million inhabitants in Spain, with three or four new cases every year); Even so, it is a serious health problem since its origin is unknown ”, he points out.

symptoms of pulmonary hypertension

“This increase in pressure and damage to the pulmonary artery will mean that the pressure will increase in the right ventricle of the heart and, therefore, in the rest of the cavities on this side of the heart muscle, which will lead to congestion of the jugular veins. and liver problems, including swelling in the legs and ankles,” he says.

“Most of the cases of pulmonary hypertension do not usually present such severe symptoms, which tend to have a worse prognosis with the passage of time,” highlights the ilerdense doctor, former head of the Cardiology Service of the San Carlos University Clinical Hospital from Madrid.

In this symptomatic aspect, shortness of breath occurs during exercise, leading to dyspnea at rest, cyanosis, chest pain, syncope, palpitations, edema in the abdomen and general fatigue.

And what treatment does pulmonary hypertension have?

“Well, logically it consists of treating the cause that produced it, that is, the primary disease: if the original disease is cardiological, we will treat the problems of the valves or the dysfunction of the ventricle and thus we will be able to reduce pulmonary hypertension.

If the cause is located in the lungs, then maximum pressure must be avoided; and prevention, with the abandonment of the tobacco habit, is also positioned as a magnificent option.

And if the disease is direct, due to PAH, we will have to use specific medicines for hospital use, generally intravenously administered.

On the horizon, we must avoid the progression and severity of pulmonary hypertension to move away from a possible lung transplant.

Dr. Carlos Macaya Miguel, professor emeritus at the Faculty of Medicine of the Complutense University of Madrid (UCM) and a world expert in interventional cardiology.