To understand what Pulmonary Hypertension (PH) is, one must first know that our body has two circulation systems. One is the major circulation system which comprises the distribution of blood driven by the left half of the heart, where the disease of arterial hypertension manifests itself, which can be measured in the arms of patients. The other system is minor circulation, where blood is driven by the right half of the heart and is sent to the lungs for oxygenation. It is in this system where pulmonary hypertension occurs, and its value can only be measured by cardiac catheterization, although a Doppler echocardiogram can provide a fairly good approximation of the real value. In this opportunity, Dr. Martin Salazar, a cardiologist at Clinica Ricardo Palma, gives us more information on the subject.

Causes

The causes of pulmonary hypertension are multiple; however, the most frequent is a cardiac failure of the left side of the heart (valve disease, dilatation of the heart due to infarction, infections, etc.). Other causes include diseases with marked pulmonary destruction such as:

• Tuberculosis
• Emphysema due to smoking
• Recurrent pulmonary thromboembolism
• Connective tissue diseases (scleroderma, lupus, etc.)
• Congenital heart disease, secondary to medication, and a group with no apparent cause called idiopathic.

Symptoms

Pulmonary hypertension, like arterial hypertension, has a long asymptomatic period. However, it may manifest depending on the degree of the disease. For example:

• The main manifestation of moderate or severe pulmonary hypertension is the sensation of shortness of breath to perform daily activities (walking, bathing, dressing).
• In more advanced stages, chest pain and swelling of the legs are present.
• In very advanced stages, there is a purplish coloration of the fingers and lips (cyanosis).

Complications

The most frequent complication is heart failure of the right side of the heart, which causes agitation, swelling of the legs, swelling of the liver (which can lead to cirrhosis), malnutrition, oxygen dependence, and a marked reduction in life expectancy. It also causes arrhythmias and sudden death.

Treatment

The most important treatment is to correct or relieve the disease causing pulmonary hypertension.  For example, operating a heart valve may correct pulmonary hypertension, if that is the cause. On the other hand, specific treatment requires an evaluation by a specialist, determining the precise values by catheterization and deciding which medication may be the most appropriate, since not all cases are treated the same. This disease is relieved but not cured.

Dr. Martin Salazar
Cardiologist at Clínica Ricardo Palma