by Dr Pandula Siribaddana

Created on: November 09, 2009

What is pulmonary hypertension?

Pulmonary hypertension is the disease state which is triggered by increase of pressure in the lung vasculature. This means that the vessels in the lungs such as the arteries, the veins as well as the capillaries will be having pressures above the normal pulmonary vascular pressure. The result would be ineffective oxygen transfer between air and the blood as well as the build up of fluids with in the lung tissues leading to ineffective lung expansion.

What are the causes for pulmonary hypertension?

There are many causes leading to build up of pulmonary hypertension and some of these conditions can be congenital, secondary to problems in the left side of the heart or else would be due to pathology in the lungs. Chronic Obstructive Pulmonary Disease (COPD) is one such example for development of pulmonary hypertension secondary to lung diseases. At times, there would not be an underlying causative factor for the pulmonary hypertension and the condition is known as 'idiopathic' pulmonary hypertension.

How does a patient present with this disease?

These patients will usually present with shortness of breath which can be progressive or some times even be acute, dry cough, bluish discolouration of skin and the peripheries due to poor oxygenation along with symptoms of heart failure.

How to prevent pulmonary hypertension?

Thus the preventive measures should aim at reducing the risk, improving left heart function, improving or minimizing the lung damage as well as to prevent embolism. Therefore, some of the measures that can be taken to address these areas will be discussed below.

1. Avoid smoking

Smoking will come on the top of the list for several reasons. Firstly, it causes direct damage to the lung tissues over time, which will give rise to non compliance in the lungs and thus poor oxygenation of blood. Secondly, it will weaken the lung vessels as well as make them stiff, thus giving rise to poor blood flow. All these event swill lead to higher pressure build up within the lungs. The result would make the heart pump against a more resistant pulmonary vasculature as well.

Although this is only one obvious explanation, there are multiple explanations on how smoking can give rise to pulmonary hypertension.

2. Correct left heart function

At times, there can be defects in the left heart such as mitral valve problems which can be present from birth or even secondary to certain disease states (e.g Rheumatic fever). In such instances, the defects will need surgical correction as if left untreated; the returning of oxygenated blood towards the heart will be impaired and thus will build up pressure within the lungs.

Apart from the valve disease, there can be other defects associated with both the atria as well as the ventricles which can give rise to pulmonary hypertension.

3. Strengthening the heart lung function

Lowering the cholesterol levels, indulging in adequate amount of exercises, balanced nutritional diet as well as relieving the stressors will support in strengthening the heart lung function and thus the disease burden from pulmonary hypertension.

4. Avoid occurrence of Deep Vein Thrombosis (DVT)

Being one of the contributors for embolism, DVT could be prevented most of the time with adequate and vigilant patient care. Bedridden patients as well as the patients following surgery are at increased risk and should be mobilized quickly or should be given passive physiotherapy in order to avoid these complications.

5. Monitoring

A patient with pulmonary hypertension would require frequent monitoring in order to detect progressive worsening. Thus, seeking medical advice and undergoing a physical assessment is a must.

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