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20 / 04 / 2018
Pulmonary Hypertension
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Pulmonary hypertension


Respiratory System


Pulmonary hypertension begins when tiny arteries in your lungs become narrow or blocked. This causes increased resistance to blood flow in your lungs, which in turn raises pressure within the pulmonary arteries. As the pressure builds, your heart's right ventricle must work harder to pump blood through your lungs, eventually causing the heart muscle to weaken and sometimes to fail completely.

Risk factors

Although anyone can develop either type of pulmonary hypertension, older adults are more likely to have secondary pulmonary hypertension whereas young people are more likely to have primary pulmonary hypertension. In addition, PPH is more common in women than it is in men.

Screening and diagnosis

In some cases, your doctor may suspect you have pulmonary hypertension based on the results of a chest X-ray or electrocardiogram (ECG) — a noninvasive test that measures electrical impulses traveling through your heart. But most often, pulmonary hypertension isn't easily detectable in the early stages.

One reason is that one of the earliest symptoms — shortness of breath — isn't always taken seriously in an otherwise healthy young person. It may be diagnosed as mild asthma or even dismissed as a nervous reaction. Because shortness of breath is subtle and slow in onset, pulmonary hypertension may not be accurately diagnosed for years.

Even when the disease is more advanced, its signs and symptoms often mimic those of other heart and lung conditions. For this reason, your doctor is likely to recommend one or more tests to rule out other possible reasons for your problem. These tests include:

  • Echocardiography (ultrasonic cardiography). This noninvasive test uses harmless sound waves that allow your doctor to see your heart without making an incision. During the procedure, a small, plastic instrument called a transducer is placed on your chest. It collects reflected sound waves (echoes) from your heart and transmits them to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor. These images show how well your heart is functioning, and recorded pictures allow your doctor to measure the size and thickness of your heart muscle. Sometimes your doctor will recommend an exercise echocardiogram to help determine how well your heart works under stress. In that case, you'll have an echocardiogram before exercising on a stationary bike or treadmill and another test immediately afterward. Traditional echocardiograms are safe and usually painless. An exercise echocardiogram carries a slight risk of a heart attack, but doctors recommend this test only when they feel it's safe.

  • Pulmonary function tests. These noninvasive tests measure how much air your lungs can hold and the airflow in and out of your lungs. They can also measure the amount of gases exchanged across the membrane between your lung wall and capillary membrane. An abnormality here may be the first indication of PPH. During the tests, you'll most likely be asked to blow into a simple instrument called a spirometer.

  • Perfusion lung scan. This test uses small amounts of radioactive tracers (radioisotopes) to study blood flow (perfusion) in your lungs. The radioisotopes are attached to substances known as radiopharmaceuticals, which are injected into a vein in your arm. Immediately afterward, a special camera (gamma camera) takes pictures of blood flow in your lungs' blood vessels. A lung scan is generally used to determine whether blood clots may be causing symptoms of pulmonary hypertension. It's usually performed in conjunction with another test known as a ventilation scan. In this test, you inhale a small amount of radiopharmaceutical while a gamma camera records the movement of air into your lungs. The entire procedure usually takes less than an hour. Although you may have some concern about exposure to radioactive material, the amount of radioactivity is too small to cause any side effects or complications.

  • Right heart catheterization. Performed on an outpatient basis using local anesthesia, this test is often the most reliable way of diagnosing pulmonary hypertension. During the procedure, your doctor places a thin, flexible tube (catheter) into a vein in your neck or groin. The catheter is then carefully threaded into your right ventricle and pulmonary artery. Right heart catheterization allows your doctor to directly measure the pressure in the main pulmonary arteries and right ventricle. It also helps your doctor evaluate the effect different drugs may have on your heart in order to find the most effective treatment for you. Possible risks of the procedure include trauma to the vein in which the catheter is inserted, the formation of blood clots at the tip of the catheter, and heart attack or stroke.

  • Fast computerized tomography (CT). A CT scan allows your doctor to see your organs in two-dimensional "slices." Split-second computer processing creates these images as a series of very thin X-ray beams pass through your body. A dye (contrast medium) is commonly used to help visualize the area. Some hospitals now use what's known as a fast CT machine. It can scan your arteries in less than 20 seconds as opposed to 20 minutes or more for a standard CT. This speed is important because it allows the dye to be visualized while still in your arteries.

  • Magnetic resonance imaging (MRI). This test uses no X-rays. Instead, a computer creates tissue "slices" from data generated by a powerful magnetic field and radio waves. Although not yet routinely used to diagnose pulmonary hypertension, it's showing great value in assessing the pulmonary arteries. It can't, however, measure artery pressure — a procedure that's necessary if you're taking medications to control PPH.

Pulmonary hypertension classifications
Once you've received a diagnosis of pulmonary hypertension, your doctor may classify the disease using guidelines developed by the New York Heart Association:

  • Class 1. Although you've been diagnosed with pulmonary hypertension, you have no symptoms.

  • Class 2. You don't have symptoms at rest, but you experience fatigue, shortness of breath or chest pain with normal activity.

  • Class 3. You're comfortable at rest but have symptoms with even slight exertion.

  • Class 4. You have symptoms even at rest.

Pulmonary hypertension > 1 > 2 > 3 > 4

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

In no event will the be liable for any decision made or action taken in reliance upon the information provided through this web site.
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Dr. Eddy Bettermann M.D.

Mob: +60.17 545 1784         +66.89 8550 5066





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