Pulmonary hypertension symptoms signs. Treating pulmonary hypertension properly

Pulmonary hypertension is a severe and common condition. The situation is exacerbated by the difficulty in identifying the causes and the absence of symptoms in some forms. An inexplicable feeling of fatigue, tachycardia and shortness of breath is a reason to see a doctor. What can the patient do to save his life?

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What is pulmonary hypertension

Pulmonary hypertension is a serious disease that refers to the pathologies of the pulmonary circulation. The patient's blood pressure rises pulmonary artery, which leads to an overload of the body. It is difficult for the patient to breathe, shortness of breath occurs and fatigue increases during exercise. Lack of treatment leads to death. Pulmonary hypertension is diagnosed when pressure is greater than 25 mm Hg. Art.

For the development of pathology, 2 factors are necessary - an increase in pressure as a result of an increase in the volume of blood flow or a change in pressure while maintaining a normal blood supply. The disease is dangerous for the patient. In some forms, the disease develops so rapidly that it causes respiratory failure.. In addition, hypertension affects a large number of organs and systems, which affects their work.

There are the following synonyms of the disease: Escudero's disease, Aerza's disease, Aerza-Arilago's disease.

Video about the disease

Causes

Hypertension often occurs with the development of lung diseases. During their progression, alveolar hypoxia is formed - main reason occurrence of pulmonary hypertension. In addition, the structure of the tissues of the organ is disturbed. The following processes also have a negative effect:

1. Chronic obstructive bronchitis. The tissues change, which leads to the overlap of the airways.
2. Bronchiectasis. Suppurations and cavities are formed in the lower lobes of the organ.
3. Fibrosis of organ tissues. Changes in healthy tissues of the organ, resulting in the replacement of normal cells with connective tissue.

Negatively affect the condition of the patient and pathology of the heart. The following groups of violations are distinguished:

1. Birth defects: defects of the interventricular or interatrial septum, open ductus arteriosus.
2. Decrease in the efficiency of the heart in certain diseases: cardiomyopathy, ischemic or hypertension.

The occlusion of the pulmonary vessels also leads to the development of hypertension. In this case, there are several ways of developing thrombosis:

1. Alveolar hypoxia. Its development occurs with uneven ventilation of the lungs. The amount of oxygen decreases, so the vessels of the body narrow.
2. Changes in lung tissue. When changing the structure of organ tissues great importance has connective tissue that replaces healthy cells and compresses blood vessels.
3. Increase in the number of red blood cells. The number of red blood cells increases as a result of prolonged hypoxia - a small or insufficient supply of oxygen. Due to insufficient oxygen, tachycardia is formed - a rapid heartbeat. Vasospasm leads to the formation of small blood clots, as a result of which the vessels overlap.

Factors contributing to the development of pathology - table

Clinical picture

Symptoms of pathology may be absent for a long time, so patients often do not seek medical help. As the disease progresses, shortness of breath occurs - main feature hypertension. It appears not only under load, but also in calm state.

Manifestations of failures respiratory function are tachycardia and hypoxia, which affects the general well-being of the patient. Not without pain syndrome. The pain is localized behind the sternum. In some cases, fainting occurs, especially during exercise.

The disease is characterized by ascites - a condition in which fluid accumulates in the abdominal cavity.

The patient feels weak, fatigue increases. Often the patient suffers from dizziness. Due to the stretching of the liver capsule and the increase in this organ, there is pain and heaviness in the region of the right hypochondrium. As a result of the accumulation of gases in the intestines, bloating occurs. In addition, the patient may suffer from nausea and vomiting. Blue extremities and edematous condition of the legs are another symptom of pathology.

In addition, the manifestations of the disease largely depend on the stage of its development.

Symptoms and signs of different stages of pulmonary hypertension - table

Forms and stages

In addition to the fact that there are 4 degrees of the disease, pulmonary hypertension is also divided into primary and secondary forms. The primary type of the disease is inherited, but there are cases when the cause of the development of the disease is unknown. In this case, we are talking about the idiopathic form. In the primary type, pathology can develop both without manifestations and with classic signs of pulmonary hypertension.

The secondary type is the result of the development of other diseases, leading to a change in pressure in the vessels that feed the lungs. Examples of such diseases are the following conditions:

1. Bronchial asthma.
2. COPD is chronic obstructive pulmonary disease.
3. Pathologies lung tissue chronic nature. They are represented by a violation of the structure of the alveoli and the development of inflammation.

Thromboembolic pulmonary hypertension of a chronic nature is associated with blockage of blood vessels. It develops quite quickly, and its beginning is stormy. The patient becomes hypoxic, blood pressure and respiratory failure occurs.

If thromboembolic manifestations have not been eliminated, then a post-embolic state is formed. This type of disease often occurs in patients who do not detect the disease in time. If the changes persist for more than 3 months, then hypertension becomes chronic.

There is a classification that takes into account the pressure of the patient. The following stages of hypertension are distinguished:

1. Light - the patient's pressure is in the range from 25 to 36 mm Hg. Art.
2. Moderate - pressure 35–45 mm Hg. Art.
3. Severe - pressure exceeds 45 mm Hg. Art.

Diagnostics

ECG is one of the main methods for diagnosing pulmonary hypertension.

A timely visit to the doctor will allow you to detect the disease in time and begin its treatment. If the patient does not have the primary type of the disease, then the disease that led to the development of the condition is necessarily identified. The first examination is the collection of data about the patient. The patient tells the doctor about the signs of hypertension that have arisen, characterizes their features. It is important to point out the presence of similar diseases in relatives, the presence of bad habits and congenital diseases.

During a general examination, a specialist can recognize swelling in the lower extremities, blue integument of the skin and swelling of the veins of the neck. The thickening of the fingers is clearly visible, which is associated with the growth of bones. A phonendoscope is used to listen to the lungs and heart.

General examination data is not enough, therefore instrumental diagnostic methods are used:

1. Echocardiography is used to assess the size of the heart and determine pressure. If there are manifestations of overload and an increase in the right heart, then this can be found out using an ECG - electrocardiography. ECG is significant method in disease detection. However, with a mild degree of pulmonary hypertension, it is not always possible to recognize pathological changes. Using the method, an overload of the right atrium is detected and manifestations of right ventricular hypertrophy are detected. Such signs are typical for the later stages of the disease, so further research is required.
2. A similar goal is for radiography. With the help of X-ray data, pathology is detected in 90% of cases. In the lateral projection, an expansion of the right ventricle and atrium is detected. In addition, the diameter of the branch of the artery located on the right increases. The method is effective, as it allows to identify pulmonary pathologies and heart defects that affect the development of pulmonary hypertension.

To directly determine the pressure of the pulmonary artery, catheterization is used. The diagnosis is made when the pressure exceeds the mark of 25 mm Hg. Art. During the diagnosis, a test for vasoreactivity can be used - the ability of an artery to expand. This is necessary to select an effective drug and predict the body's response to the treatment used.

In addition, you will need to consult several doctors, especially a cardiologist and a pulmonologist. The possibilities of diagnostics do not end there, since there are a lot of additional tools that allow you to form a complete picture of the disease. The following methods are applied:

1. Angiopulmonography - assesses the condition of the vessels of the lungs.
2. Computed tomography - examine the organs of the chest.
3. Body plethysmography and spirometry - evaluate breathing.
4. Expanded coagulogram - eliminate the predisposition to the formation of blood clots, as the indicators of blood clotting are examined.
5. Immunological analysis is used to detect antibodies to body cells.
6. General and biochemical analysis blood.
7. Walking test for 6 minutes - to determine the degree of exercise tolerance. It also allows you to determine the functional class of the disease.
8. Ultrasound diagnostics of the abdominal organs (ultrasound).
9. The study of the gas composition of the blood.

Treatment

Medical

The basis of the treatment of any disease is the prescription of drugs. Pulmonary hypertension is no exception. To normalize the patient's condition, several groups of medicines are used.

It is allowed to use medicines only after receiving recommendations from a doctor.

Calcium antagonists can reduce the degree of spasm and change the heart rate. As a result of the use of such funds, the muscles of the bronchi relax, and the degree of platelet adhesion decreases. Therefore, the appointment of calcium antagonists leads to a decrease in the load on the heart. However, these drugs may not help all patients. To find out the need for the appointment of such funds, the specialist probes the right side of the organ. The following drugs are prescribed:

1. Amlodipine.
2. Nifedipine.
3. Diltiazem.

For removing excess water use diuretics. Removal of unnecessary fluid leads to a decrease in pressure. During therapy, the degree of blood viscosity and electrolyte composition must be monitored. Tools such as:

1. Furosemide.
2. Torasemide.
3. Ethacrynic acid.

To lower the pressure, ACE inhibitors (angiotensin-converting enzyme) are used, which dilate the blood vessels. Apply:

1. Captopril.
2. Enalapril.
3. Lisinopril.
4. Fosinopril.
5. Cilazapril.
6. Ramipril.

Antiplatelet agents are needed to reduce the degree of agglutination of red blood cells and platelets. This group is represented by acetylsalicylic acid. A useful component from the group of phosphodiesterase 5 inhibitors is sildenafil, which dilates the arteries of the lungs. To prevent the development of thrombosis, direct-acting anticoagulants are used:

1. Heparin.
2. Danaparoid.

Sildenafil is present in the well-known drug for the treatment of erectile dysfunction - Viagra.

Improving ventilation of the lungs is another important task of therapy - bronchodilators cope with this purpose. They are especially useful in bronchial asthma and other conditions accompanied by bronchospasm. Assigned funds such as:

1. Fenoterol.
2. Formoterol.
3. Theophylline.
4. Aminophylline.

When an infection is connected, antibiotics are prescribed.

Medications in the photo

Diet and lifestyle

An important condition for treatment is patient compliance with the established rules:

• It is necessary to reduce fluid intake to 1.5 liters per day.
• It is recommended to reduce the amount of salt in food.
• It is important to avoid the formation of shortness of breath and painful manifestations. For this purpose, the load is normalized, which will not lead to discomfort or fainting.

The patient is advised to eat right to reduce the risk of deterioration of health. There are no exact recommendations on the diet, since the diet is compiled on an individual basis and differs in each case. Against the background of the development of pulmonary hypertension, other diseases are also formed: obesity, atherosclerosis and diabetes mellitus. This leaves its mark on catering. The patient needs food with a lot of vitamins - it is on this principle that a diet is made. It is allowed to use:

• fresh fruits and vegetables in the form of salads: cucumbers, zucchini, tomatoes, pumpkin; sauerkraut.
• nuts, cereals and fish;
• poultry;
• soups: dairy, vegetarian, fruit;
• cereals: buckwheat, oatmeal, millet.
• cheese and low-fat cottage cheese;
• potatoes and peas in moderation;
• bread - no more than 200 g per day, only rye is suitable;
• foods rich in potassium and magnesium.

The diet of the patient is limited, therefore, adhere to the following rules:

• Do not drink alcohol.
• Reduce the proportion of foods high in cholesterol.
• Avoid coffee and caffeinated products completely.
• Reduce the amount of sweets.
• Fatty meat is consumed only with the permission of a doctor.

Foods rich in magnesium and potassium - photo gallery

Physiotherapy

Oxygen therapy is a component of complex treatment of pulmonary hypertension. Such treatment restores the efficiency of the central nervous system and relieves the patient of the accumulated fluid in the blood. This leads to a violation of the mechanism of development of pulmonary hypertension. Simultaneously with the above therapy, anicoagulants are used to improve blood microcirculation. Potassium orotate and Riboxin contribute to the improvement of metabolism.

With an increase in venous pressure, another method is used - bloodletting. During the first procedure, the volume of blood collected does not exceed 50 ml. After 2 or 3 days, a second procedure is performed, releasing 200-300 ml of blood.

Surgical

If treatment with the help of drug tactics has not shown high efficiency, then they resort to the use of surgical intervention. The choice of method depends on the characteristics of the development of the pathology and the individual characteristics of the patient. An atrial septostomy is often used, which improves blood flow in a large circle. During the operation, a special opening is created between the left and right atrium, which leads to a decrease in pressure.

In advanced cases of hypertension resort to lung transplantation or heart-lung complex. The presence of severe pathologies of the heart, for example, muscle enlargement and organ valve insufficiency, are contraindications for intervention. In addition, contraindications include:

1. Poor condition of the patient and his weakness.
2. Elderly age.
3. Low degree of oxygenation - saturation of the blood with oxygen.

Embolectomy is the surgical removal of a blockage in a blood vessel. For this, a catheter is used, which is inserted through a small incision in the wall of the artery. General contraindications are similar to similar characteristic transplants. However, during embolectomy, attention is paid to the presence of severe pathologies with an unfavorable prognosis. This is about cancer. In addition, do not prescribe embolectomy for lesions of cardio-vascular system especially if there is an unjustified risk.

Folk remedies

Pumpkin juice reduces the risk of blood clots

The use of folk remedies is of secondary importance. These methods are effective only with the simultaneous use of official medicine. Before starting treatment, it is recommended to consult a doctor and exclude the presence of intolerance to the components.

• Pumpkin juice. Used to reduce blood viscosity. This drink is not only pleasant, but also useful. With its help, the likelihood of blood clots is reduced, which favorably affects the course of the pathology and the patient's well-being.
• Rowan juice. It is used to improve blood circulation in the lungs. Stimulation of blood circulation is an important task during the treatment of pulmonary hypertension, so this drink is difficult to do without. To prepare the composition, you should take ripe rowan berries in the amount of 1 tbsp. l. Berries and 1 glass of water are added to the pan, then the mixture is cooked for 10 minutes over low heat. After cooling the drink, you can use it 2 times a day for 0.5 cups.

Prognosis and possible complications

Pulmonary hypertension is a serious disease, so treatment should be immediate. Lack of therapy aggravates the course of the pathology, resulting in an increased likelihood of death.

In the idiopathic form of hypertension, there is no opportunity to influence the provoking factor, so this type has unfavorable prognosis. According to statistics, the survival rate of patients is 12–20%. However, with timely initiation of therapy, the prognosis increases significantly to 28–39%.

Lack of intervention or late initiation of treatment can lead to complications. There is a possibility of a transition from the primary form to the secondary type, as a result of which the patient's condition will worsen. A common complication is increased oxygen deficiency, which leads to poor tissue nutrition. The patient develops shortness of breath, which occurs even when at rest. In addition, hypoxia increases blood viscosity, which leads to the formation of blood clots, clogging of blood vessels.

Pulmonary edema is often observed in hypertensive crises. The patient has an increased feeling of suffocation, which occurs especially often at night. The condition is accompanied by a strong cough with sputum production, and in some cases hemoptysis is observed. The skin becomes bluish, the neck veins swell and pulsate. The lethal outcome is more often associated with arterial thromboembolism or acute and chronic cardiopulmonary insufficiency.

Prevention measures

Preventive measures are presented general rules. The patient is prohibited from drinking alcohol and tobacco products. Doing healthy lifestyle life is the basis of well-being. If pulmonary hypertension was caused by a specific disease, then it needs to be eliminated.

Physical activity is beneficial. Exercise improves blood circulation and helps prevent blood clots. However, it is recommended to exercise treat with care, as excessive load will lead to the opposite result. Hiking in the fresh air or doing gymnastics is useful. A set of exercises is developed jointly with a specialist. Take into account the indications for stress, the characteristics of the course of the disease and the individual capabilities of the patient. The patient should visit the doctor more often for examination.

It is important to keep your emotional level normal. Good mood- the key to recovery, and stress and nervousness will only aggravate the course of pulmonary hypertension. Patients are advised to avoid conflict situations.

Preventive measures include proper nutrition. Providing the body with vitamins is an important component of health. Help will come not only vitamin complexes but also natural ingredients - fresh vegetables and fruits. This is especially true for people living in cold climates, in the north.

Pulmonary hypertension and pregnancy

Pulmonary hypertension is dangerous during pregnancy, the probability of death reaches 50%. If the condition is detected in a timely manner, then the risks are significantly reduced, since the main reason for the loss of the fetus or the death of the mother is the late seeking medical help.

Several specialists are involved in the treatment of the patient. This reduces the risk, allows steps to be taken to emergency assistance and the salvation of mother and child. Pharmacological therapy is carried out by the following means:

1. analogues of prostacyclin.
2. Phosphodiesterase inhibitors.
3. Endothelin antagonists.

Additionally, the following methods and means are used:

1. Oxygen therapy.
2. Diuretics.
3. Anticoagulants.
4. inotropic substances.
5. Nitric oxide.

The development of the disease in children

In some cases, pulmonary hypertension occurs in children and infants. In newborns, the onset of the disease is associated with the congenital nature of a diaphragmatic hernia, in which one of the lungs receives more blood.

What distinguishes pulmonary hypertension in children from a similar disease in adults? AT childhood increases the likelihood of further progression of the disease. It has to do with the body of the child and his individual development affecting the vessels of the lungs and the organ itself. External influences also have a negative effect, since it is difficult for the child's body to resist them. Such factors include impacts that lead to a slowdown in development and a deterioration in adaptation.

The main factors in the formation of pulmonary hypertension in children include acquired or congenital damage. Chronic lung pathologies negatively affect children's health. Early detection of the disease will prevent the development of hypertension, since the degree of survival directly depends on the stage of the pathology.

Tips for parents of children suffering from this disease - video

Thus, recovery and a reduction in the risk of complications depend on the actions of the patient. You cannot treat the pathology on your own, so the patient's task is to seek help from a doctor. Only in this case and subject to the established rules, the prognosis is favorable for the patient.

Pulmonary hypertension (PH) is pathological condition which is characterized by poor health and high blood pressure. The disease without timely intervention gradually progresses and leads to serious disruption and damage to the right ventricle of the heart muscle.

Pathology is characterized by severe symptoms that can lead to death. It is important to detect the disease in time and proceed with the prevention. negative consequences.

What is pulmonary hypertension?

Pulmonary hypertension is a narrowing of the vessels of the lungs, which leads to an overload of the right ventricle of the heart and is manifested by high blood pressure. Most often, the disease is a secondary syndrome due to other disorders in the cardiovascular system. But PH can also be an idiopathic pathology.

ATTENTION! Main hallmark hypertension is pulmonary arterial pressure above 25 mmHg. Its constant deviation from the norm and the development of pathology leads to disruption and cessation of myocardial functionality, which in a short time can lead to death.

Developing PH is able to influence the state of the entire cardiovascular system, affecting its precapillary (arterioles) and postcapillary (venules) departments, which are responsible for resistance to blood flow in the vessels of internal organs.

The most common primary and secondary types of pulmonary hypertension occur in young women aged 20 to 40 years. The causes of their occurrence and the further development of the disease differ in etiology.

Primary

Pulmonary idiopathic arterial hypertension (Aerz's disease) is a rare disease, in most cases - inherited. A characteristic manifestation of primary PH is a change in the size of the right ventricle and pathological lesions of the pulmonary artery.

The disease progresses rapidly, which puts people who suffer from it at risk of early death. It is possible to prevent it with the timely detection of hypertension, which is characterized by vivid symptoms, as well as with its mandatory treatment.

Secondary

Secondary PH is not separate view diseases, but a complication of already existing diseases, due to which it occurs. Among them:

• autoimmune diseases, in particular HIV;
• connective tissue diseases;
• the presence of CHD (congenital heart disease);
• diseases and pathologies of the respiratory system;
• left ventricular failure.

The manifestation of external and internal signs of hypertension in its secondary form does not differ from idiopathic PH, with the exception of concomitant symptoms of diseases that provoked the development of pathology.

REFERENCE! This type of disease is more common than its primary form, it is curable with timely diagnosis and the cause of the complication.

Classification of the disease according to the nature of the course

Pulmonary hypertension, depending on the complexity and nature of the course of the disease, is classified according to degrees according to the ICD:

1. 1st degree, characterized by the absence of severe symptoms, especially in people suffering from hypertension. Pathology begins to develop gradually, blood pressure will be slightly increased, while the muscle activity and well-being of the patient remain unchanged.
2. 2nd degree, in which blood pressure increases, the first external signs of pathology appear, manifested after physical activity in the form of shortness of breath, fatigue, impaired coordination. It is also possible to lose strength with a deterioration in the patient's well-being.
3. Grade 3 is characterized by increased symptoms of hypertension even at rest and with little physical activity. The patient's blood pressure will be significantly elevated even in the presence of hypertension.
4. The 4th degree, which is the last, is characterized by pronounced symptoms with painful sensations and constant weakness. Blood pressure at this stage of the development of the pathology will be significantly higher than the normal limits, the patient's physical activity will become as difficult as possible.

ATTENTION! It is important not to start the disease to the extreme stage, which in many cases ends in death. The patient needs to monitor blood pressure and well-being.

Causes of the disease

Alexander Bakulev, one of the founders of cardiovascular surgery, and Leo Bokeria, a well-known Soviet cardiac surgeon, studied the characteristics of cardiovascular disease, as well as the definition of the main causes of PH and the treatment measures that depend on them.

The main reasons for the development of PH include chronic diseases and pathological changes in the heart muscle and respiratory system:

• obstructive bronchitis;
• bronchial asthma and chronic tuberculosis;
• bronchiectasis (formation of cavities and suppuration in the lungs);
• fibrosis of lung tissue caused by pathological changes in the body;
• congenital heart defects, in particular, defects of the mitral valve, defects of the interatrial and interventricular septa, defects of the ventricles and valves;
• diseases that lead to dysfunction circulatory system and leading to stagnation of blood (cardiomyopathy, ischemic heart disease, pulmonary embolism);
• alveolar hypoxia, which is the most common cause of PH;
• defects in the structure of lung tissues;
• attacks of hypertension, hypertensive crises;
• deviations of the blood structure from the norm due to increased concentration erythrocytes;
• HIV infection;
• cirrhosis of the liver in an advanced stage;
• acquired mitral valve prolapse;
• portal hypertension, characterized by increased pressure in the portal vein due to lesions of the liver;
• hyperthyroidism, in which there is an excessive secretion of thyroid hormones;
• neoplasms in the chest, its deformation;
• compression of the pulmonary vessels due to obesity;
• intracranial hypertension arising from pathologies of the brain with a concomitant increase in intracranial pressure;
• left ventricular failure;
• disorders of metabolism and metabolic processes in the body.

External factors can also provoke the occurrence of pulmonary hypertension, including:

• prolonged use of narcotic drugs, antidepressants and anorexigens;
• the impact of toxins and biological poisons when living in places with poor ecology;
• the period of pregnancy, especially in women suffering from hypertension;
• accommodation and frequent stay in the highlands.

Often, PH occurs as a result of several causes at once in the form of diseases of the cardiovascular and respiratory systems.

Symptoms of the development of PH

At the 1st stage of development, pulmonary hypertension often does not manifest itself, with the exception of a slight increase in blood pressure.

The progression of the disease occurs gradually, its symptoms begin to appear already at the 2nd stage. Clinical picture PH includes the manifestation of such signs:

1. Shortness of breath, difficulty breathing at rest, aggravated by physical activity.
2. Increased heart rate (attacks of tachycardia), resulting from respiratory failure and hypoxia.
3. Painful sensations of a squeezing nature in the chest.
4. Fainting states.
5. Increased fatigue and constant weakness.
6. Vertigo.
7. Attacks of suffocation at night.
8. Swelling of the extremities.
9. Blueness of the skin.
10. Pain in the liver, resulting from its pathological increase in volume.
11. Soreness and heaviness in the right hypochondrium.
12. Gastrointestinal disorders in the form of nausea, vomiting, bloating and flatulence.
13. Sudden and rapid weight loss.
14. Attacks of dry cough with hoarseness.
15. Coughing fits with expectoration and blood.
16. Swelling and bulging of the veins in the neck.

IMPORTANT! The manifestation of symptoms occurs with an increase in blood pressure by 2 times or more. In children, in particular in toddlers, symptoms appear more severely and at an accelerated pace, which is why it is important to monitor their health.

Diagnostic measures

To determine pulmonary hypertension, you need to undergo a complete examination in a medical institution. Passage of diagnostics includes the following research methods:

• Examination by the physician of the patient's history and family history of the disease to establish possible causes development of pathology.
• Examination and questioning of the patient, in which he should inform the doctor about the features of the manifestation of symptoms, about well-being and the presence of concomitant chronic diseases.
• ECG, which allows to identify the presence of abnormalities in the work and structure of the right ventricle, to analyze its activity.
• x-ray thoracic, according to the picture of which it is possible to determine the increase in the size of the heart muscle and its departments.
• EchoCG, which allows you to find out the speed of blood flow in the chest area, as well as possible deviations in the heart muscle.
• Ultrasound of the heart, during which it is possible to assess and analyze the state of the structure of the heart muscle, its size and the approximate pressure of the pulmonary artery.
• Catheterization of the pulmonary artery, necessary to clarify the blood pressure in it.
• Passing blood tests (general and biochemical) to determine its composition and compare it with a special code, deviations from which indicate a malfunction in the body.
• Angiopulmonography, during which it is possible to assess the condition of the vessels of the lungs.
• CT, the results of which can determine the size of the pulmonary artery and the presence of concomitant diseases and pathologies of the heart muscle and lungs.
• A test for determining endurance and exercise tolerance, contributing to the diagnosis and clarification of the stage of development of PH.

Also, to exclude diseases with similar symptoms, differential diagnosis can be carried out using:

• coagulograms to determine blood clotting (excluding thrombosis);
• Ultrasound of the abdominal organs (exclusion of gastrointestinal diseases);
• liver function tests (exclusion of cirrhosis and hepatitis);
• HIV test.

Only a thorough examination can establish exact disease and determine its stage for further treatment.

Methods of treatment

Pulmonary hypertension is treated by a therapist and a cardiologist. Its methods depend on the stage of progression of the pathology, general condition the patient and his individual characteristics.

Regardless of the cause of the disease and the degree of its development, the treatment algorithm is as follows:

1. Identification and elimination of the root cause of the disease.
2. Decreased blood pressure in the lungs.
3. Prevention of thrombosis in the arteries.
4. Symptomatic treatment of the patient.

Comprehensive therapy based on these principles includes:

• the use of a course of drugs in the form of tablets and injections;
• basic treatment of a patient suffering from PH;
• the use of traditional medicine;
• surgical intervention in severe stages of pathology.

REFERENCE! Symptomatic therapy may be included in the treatment to eliminate the causes that provoke the development of PH and other pathologies, as well as radiation therapy if a tumor is detected in the lung that has arisen against hypertension.

Medical therapy

The use of drugs is necessary to eliminate the cause of the pathology and alleviate the patient's condition. Mandatory medications include:

1. Calcium antagonists - to reduce spasm of the vessels of the pulmonary circulation, reduce platelet adhesion and eliminate hypoxia ("Nifedipine", "Verapamil").
2. Diuretics and diuretics - to remove excess fluid from the body and lower blood pressure ("Lasix", "Veroshpiron").
3. ACE inhibitors and vasodilators - to reduce pressure, dilate blood vessels and reduce the load on the heart muscle ("Quadropril", "Lizinopril").
4. Nitrates - to reduce the load on the heart ("Kardix", "Nitromint").
5. Antiplatelet agents - to normalize the content and activity of erythrocytes and platelets in the blood ("Clopidogrel", "Iloprost").
6. Anticoagulants - to prevent thrombosis ("Aspinat", "Dethromb").
7. Endothelin receptor antagonists - for vasodilatation ("Bosentan", "Sitaxentan").
8. Vasodilators - to relax the smooth muscle layer of blood vessels ("Nifedipine", "Prazosin").
9. Bronchodilators - to restore and improve ventilation of the lungs ("Fenoterol", "Berodual").
10. Antibiotics - to cure bronchopulmonary infections, if any (Azitrox, Fromilid).
11. Prostaglandins - for enhanced vasodilation and prevention of thrombosis ("Vazaprostan", "Edex").

It is also acceptable to use symptomatic drugs to alleviate the general condition of the patient. Their reception should be prescribed by a doctor in the required amount, depending on the severity of the symptoms.

Basic treatment on an ongoing basis for PH

In addition to taking medication, it is important to adhere to the basic treatment in the presence of pulmonary hypertension. It is based on the following guidelines and requirements:

• reducing the amount of fluid consumed to 1.5 liters per day;
• reducing the amount of salt consumed;
• carrying out oxygen inhalations;
• compliance with the dosing of physical activity;
• the exclusion of heavy physical exertion, in particular, lifting to a height;
• control of mental and emotional state;
• refusal of bad habits, the use of strong caffeinated, tonic and alcoholic beverages.

IMPORTANT! Exclusively basic treatment is not able to affect getting rid of PH, but in combination with medical and surgical (if necessary) therapy, it has a positive effect on the patient's health.

Surgical intervention

Severe degrees of development of pulmonary hypertension require surgery. Surgical intervention, depending on the neglect of the pathology, can take place in one of the following forms:

• Creation of an artificial opening between the atria of the heart muscle to reduce pressure in the right ventricle.
• Elimination of blood clots in the vessels of the lungs.
• Heart and/or lung transplantation in severe cases of pathology in the presence of irreversible changes and chronic diseases.

Operations in most cases are successful, but require long-term rehabilitation of patients.

ethnoscience

Traditional medicine contributes to the treatment of pulmonary hypertension, strengthens and enhances the effect of mandatory drug therapy. Effective recipes include:

1. Rowan decoction. Need 1 tbsp. l. berries pour 100 ml of water, boil and let cool. Take the drug should be 0.5 cup three times a day. The decoction helps to normalize blood pressure and strengthen blood vessels.
2. A decoction of viburnum. It is necessary to pour 20 g of berries into 200 ml of hot water and boil, let the product brew for an hour. It is recommended to use the product 50 ml once a day. It lowers blood pressure and boosts immunity.
3. Garlic. It is necessary to eat 3 cloves 1 time daily to maintain normal pressure and cleanse the venous tract.
4. Decoction of Adonis. It should be 1 tsp. dried herbs pour 200 ml of boiling water, let it brew for 2 hours. You need to take the remedy for 2 tbsp. l. a day before meals, which will favorably affect the restoration of blood pressure;
5. Decoction of birch buds. It should be 1 tsp. swollen crushed dry kidneys pour 200 ml of water and boil half in a water bath. Strain the broth and take 1 glass during the day to normalize the pressure.
6. Melissa infusion. You need 1 tsp. dry leaves pour 250 ml of boiling water and let it brew for 30 minutes. The tool should be squeezed out and taken 1 tbsp. l. three times a day. Infusion allows you to reduce blood pressure.

ATTENTION! Traditional medicine is allowed to be taken only after discussion with the doctor!

Possible consequences and complications of the disease

Pulmonary hypertension in the course of its development can lead to negative consequences and complications in the form of chronic diseases and pathologies. These include:

• right ventricular failure;
• thrombosis of pulmonary arteries, thromboembolism;
• arrhythmia, atrial fibrillation;
• hypertensive crises;
• pulmonary edema.

Such severe complications without timely therapeutic intervention can lead to disability and further death.

Forecast and prevention

The prognosis of PH disease with timely treatment most often favorable. In the absence of timely diagnosis and therapy, the prognosis worsens significantly. It is also influenced by the cause of the development of pathology. So, in the absence of concomitant severe and chronic symptoms, the chance of recovery increases significantly, and in the presence of severe diseases of the cardiovascular system, on the contrary, the risk of death increases.

To avoid the development of pulmonary hypertension, it is recommended to follow simple preventive rules:

• lead a healthy and active image life;
• give up bad habits in the form of smoking and alcohol abuse;
• do not delay treatment infectious diseases;
• observe the measure during physical activity;
• avoid stressful situations, emotional outbursts.

Conclusion

Pulmonary hypertension can be fatal. Severe symptoms of the disease require immediate treatment to the clinic for diagnosis and therapy. It is important to monitor your health, maintain a healthy lifestyle and visit doctors regularly to prevent the development of hypertension, its progression and the occurrence of complications.

Pulmonary hypertension (PH) is characteristic of diseases that are completely different both in terms of their causes and defining features. LH is associated with the endothelium (inner layer) of the pulmonary vessels: growing, it reduces the lumen of arterioles and disrupts blood flow. The disease is rare, with only 15 cases per 1,000,000 people, but survival is very low, especially in primary PH.

The resistance in the pulmonary circulation increases, the right ventricle of the heart is forced to increase contractions in order to push blood into the lungs. However, it is not anatomically adapted to long-term pressure loading, and with PH in the pulmonary artery system, it rises above 25 mm Hg. at rest and 30 mmHg during exercise. First, in a short period of compensation, there is a thickening of the myocardium and an increase in the right parts of the heart, and then a sharp decrease in the strength of contractions (dysfunction). The result is premature death.

Why does PH develop?

The causes of the development of PH have not yet been finally determined. For example, in the 60s in Europe there was an increase in the number of cases associated with the excessive use of contraceptives and weight loss agents. Spain, 1981: Complications of muscle damage following the popularization of rapeseed oil. Almost 2.5% of 20,000 patients were diagnosed with arterial pulmonary hypertension. The root of evil was the tryptophan (amino acid) present in the oil, this was scientifically proven much later.

Dysfunction (dysfunction) of the pulmonary vascular endothelium: the cause may be a hereditary predisposition, or the influence of external damaging factors. In any case, the normal balance of nitric oxide metabolism changes, the vascular tone changes towards spasm, then inflammation, endothelial growth and a decrease in the lumen of the arteries begin.

Violation of the synthesis or availability of nitric oxide (NO), a decrease in the level of prostacyclin production, additional excretion of potassium ions - all deviations from the norm lead to arterial spasm, proliferation muscular wall vessels and endothelium. In any case, the final development is a violation of blood flow in the pulmonary artery system.

Signs of the disease

Moderate pulmonary hypertension does not give any severe symptoms, this is the main danger. Signs of severe pulmonary hypertension are determined only in the later periods of its development, when pulmonary arterial pressure rises, compared with the norm, by two or more times. The norm of pressure in the pulmonary artery: systolic 30 mm Hg, diastolic 15 mm Hg.

Initial symptoms of pulmonary hypertension:

• Unexplained shortness of breath, even with little physical activity or at complete rest;
• Gradual weight loss even with a normal, nutritious diet;
• Asthenia, constant feeling of weakness and impotence, depressed mood - regardless of the season, weather and time of day;
• Persistent dry cough, hoarse voice;
• Discomfort in the abdomen, a feeling of heaviness and "bursting": the onset of blood stagnation in the portal vein system that conducts venous blood from the intestines to the liver;
• Dizziness, fainting - manifestations of oxygen starvation (hypoxia) of the brain;
• Rapid heartbeat, over time, the pulsation of the jugular vein becomes noticeable on the neck.

Later manifestations of PH:

1. Blood-streaked sputum and hemoptysis: signal increasing pulmonary edema;
2. Attacks of angina (chest pain, cold sweat, fear of death) - a sign of myocardial ischemia;
3. Arrhythmias (cardiac arrhythmias) of the type of ciliated.

Pain in the hypochondrium on the right: the systemic circulation is already involved in the development of venous stasis, the liver has enlarged and its shell (capsule) has stretched - therefore, pain has appeared (the liver itself does not have pain receptors, they are located only in the capsule)

Edema of the legs, in the region of the legs and feet. Accumulation of fluid in the abdomen (ascites): manifestation of heart failure, peripheral blood stasis, decompensation phase - a direct danger to the patient's life.

Terminal stage of HT:

• Thrombi in the arterioles of the lungs lead to the death (infarction) of the active tissue, an increase in suffocation.

Hypertensive crises and attacks of acute pulmonary edema: more often occur at night or in the morning. They begin with a feeling of a sharp lack of air, then a strong cough joins, bloody sputum is released. The skin becomes bluish (cyanotic) and the veins in the neck throb. The patient is excited and frightened, loses self-control, can move chaotically. At best, the crisis will end copious excretion light urine and uncontrolled excretion of feces, at worst - fatal. The cause of death may be the blockage of a thrombus (thromboembolism) of the pulmonary artery and subsequent acute heart failure.

The main forms of PH

1. Primary, idiopathic pulmonary hypertension (from the Greek idios and pathos - "a kind of disease"): is fixed as a separate diagnosis, in contrast to secondary PH associated with other diseases. Variants of primary PH: familial PH and a hereditary predisposition of blood vessels to dilate and bleed (hemorrhagic telangiectasias). The reason is genetic mutations, the frequency is 6-10% of all cases of PH.
2. Secondary PH: manifests itself as a complication of the underlying disease.

Systemic diseases of the connective tissue - scleroderma, rheumatoid arthritis, systemic lupus erythematosus.

Congenital heart defects (with discharge of blood from left to right) in newborns, occurring in 1% of cases. After blood flow-correcting surgery, the survival of this category of patients is higher than in children with other forms of PH.

Late stages of liver dysfunction, pulmonary-hepatic vascular pathologies in 20% give a complication in the form of PH.

HIV-infection: PH is diagnosed in 0.5% of cases, survival within three years drops to 21% compared with the first year - 58%.

Intoxication: amphetamines, cocaine. The risk increases three dozen times if these substances have been used for more than three months in a row.

Blood diseases: in some types of anemia, 20-40% are diagnosed with PH, which increases the mortality among patients.

Chronic obstructive pulmonary disease (COPD), caused by long-term inhalation of particles of coal, asbestos, shale and toxic gases. It often occurs as an occupational disease among miners, workers in hazardous industries.

Syndrome sleep apnea: partial cessation of breathing during sleep. Dangerous, found in 15% of adults. The consequence may be PH, stroke, arrhythmias, arterial hypertension.

Chronic thrombosis: noted in 60% after a survey of patients with pulmonary hypertension.

Lesions of the heart, its left half: acquired defects, coronary disease, hypertension. About 30% is associated with pulmonary hypertension.

Diagnosis of pulmonary hypertension

Diagnosis of precapillary PH (associated with COPD, arterial pulmonary hypertension, chronic thrombosis:

• Pulmonary artery pressure: mean ≥ 25 mm Hg at rest, more than 30 mm Hg with exertion;
• Increased pulmonary artery wedge pressure, blood pressure inside the left atrium, end diastolic ≥15 mm, pulmonary vascular resistance ≥ 3 units. Wood.

Postcapillary PH (for diseases of the left half of the heart):

1. Pulmonary artery pressure: mean ≥25 (mmHg)
2. Initial: >15 mm
3. Difference ≥12 mm (passive LH) or >12 mm (reactive).

ECG: congestion on the right: ventricular enlargement, expansion and thickening of the atrium. Extrasystole (extraordinary contractions of the heart), fibrillation (chaotic contraction of muscle fibers) of both atria.

X-ray study: increased peripheral transparency of the lung fields, enlarged lung roots, heart borders shifted to the right, the shadow from the arch of the dilated pulmonary artery is visible on the left along the cardiac contour.

photo: pulmonary hypertension on x-ray

Functional breathing tests, qualitative and quantitative analysis of the composition of gases in the blood: the level of respiratory failure and the severity of the disease are revealed.

Echocardiography: the method is very informative - it allows you to calculate the value of the average pressure in the pulmonary artery (MPAP), diagnose almost all defects and hearts. PH is recognized already in the initial stages, with SPPA ≥ 36–50 mm.

Scintigraphy: in PH with blockage of the lumen of the pulmonary artery by a thrombus (thromboembolism). The sensitivity of the method is 90 - 100%, specific for thromboembolism by 94 - 100%.

Computed (CT) and magnetic resonance imaging (MRI): at high resolution, in combination with the use of a contrast agent (at CT), they allow assessing the condition of the lungs, large and small arteries, walls and cavities of the heart.

Insertion of a catheter into the cavities of the "right" heart, testing the response of blood vessels: determining the degree of PH, blood flow problems, assessing the effectiveness and relevance of treatment.

Treatment of PH

It is possible to treat pulmonary hypertension only in the complex, bringing together general recommendations to reduce the risk of exacerbations; adequate therapy of the underlying disease; symptomatic means of influencing the general manifestations of PH; surgical methods; folk remedies and unconventional methods– only as ancillary.

Vaccination (influenza, pneumococcal infections): for patients with autoimmune systemic diseases - rheumatism, systemic lupus erythematosus, etc., to prevent exacerbations.

Nutrition control and dosed physical activity: in case of diagnosed cardiovascular insufficiency of any genesis (origin), in accordance with the functional stage of the disease.

Prevention of pregnancy (or, if indicated, even its termination): the circulatory system of mother and child are connected together, an increase in the load on the heart and blood vessels of a pregnant woman with PH can lead to death. According to the laws of medicine, the priority in saving a life always belongs to the mother, if it is not possible to save both at once.

Psychological support: all people with chronic diseases constantly experiencing stress, the balance of the nervous system is disturbed. Depression, a sense of uselessness and burdensomeness for others, irritability over trifles - a typical psychological portrait of any "chronic" patient. Such a condition worsens the prognosis for any diagnosis: a person must definitely want to live, otherwise medicine will not be able to help him. Conversations with a psychotherapist, activities to your liking, active communication with friends in misfortune and healthy people- an excellent basis to feel the taste for life.

Supportive care

• Diuretic drugs remove accumulated fluid, reducing the workload on the heart and reducing swelling. Be sure to control the electrolyte composition of the blood (potassium, calcium), blood pressure and kidney function. An overdose threatens with too much water loss and pressure drop. With a decrease in potassium levels, arrhythmias begin, muscle cramps indicate a decrease in calcium levels.
• Thrombolytics and anticoagulants dissolve already formed blood clots and prevent the formation of new ones, ensuring vascular patency. It is necessary to constantly monitor the state of the blood coagulation system (platelets).
• Oxygen (oxygen therapy), 12 - 15 liters per day, through a humidifier: for patients with chronic obstructive pulmonary disease (COPD) and cardiac ischemia, helps to restore blood oxygen saturation and stabilize the general condition. It must be remembered that too much oxygen concentration depresses the vasomotor center (SDC): breathing slows down, blood vessels expand, pressure drops, the person loses consciousness. For normal operation, the body needs carbon dioxide, it is after an increase in its content in the blood that the SDC "gives the command" to take a breath.
• Cardiac glycosides: active components are isolated from foxglove, Digoxin is the most famous of the drugs. Improves heart function by increasing blood flow; fights against arrhythmias and vascular spasm; reduces swelling and shortness of breath. In case of overdose - increased excitability of the heart muscle, rhythm disturbances.
• Vasodilating: the muscular wall of arteries and arterioles relaxes, their lumen increases and blood flow improves, pressure in the pulmonary artery system decreases.
• Prostaglandins (PG): group active substances are produced in the human body. In the treatment of PH, prostacyclins are used, they relieve vascular and bronchial spasm, prevent the formation of blood clots, block the growth of the endothelium. Very promising drugs, effective in PH on the background of HIV, systemic diseases (rheumatism, scleroderma, etc.), heart defects, as well as familial and idiopathic forms of PH.
• Endothelin receptor antagonists: vasodilation, suppression of growth (proliferation) of the endothelium. With prolonged use, shortness of breath decreases, the person becomes more active, pressure normalizes. Undesirable reactions to treatment are edema, anemia, disruption of the liver, so the use of drugs is limited.
• Nitric oxide and PDE type 5 (phosphodiesterase) inhibitors: mainly used in idiopathic PH, if standard therapy does not justify itself, but some drugs are effective in any form of PH (Sildenafil) Action: reduction of vascular resistance and associated hypertension, facilitation of blood flow, resulting in increased resistance to physical activity. Nitric oxide is inhaled daily for 5-6 hours, up to 40 ppm, the course is 2-3 weeks.

Surgical treatments for PH

Balloon atrial septostomy: performed to facilitate the dumping of oxygen-rich blood inside the heart, from left to right, due to the difference in systolic pressure. A catheter with a balloon and a blade is inserted into the left atrium. The blade cuts the septum between the atria, and the inflated balloon expands the hole.

Lung transplantation (or lung-heart complex): performed according to vital indications, only in specialized medical centers. The operation was first performed in 1963, but by 2009 more than 3,000 successful lung transplants were performed annually. The main problem is the lack of donor organs. Lungs are taken from only 15%, heart from 33%, and liver and kidneys from 88% of donors. Absolute contraindications for transplantation: chronic renal and hepatic insufficiency, HIV infection, malignant tumors, hepatitis C, the presence of HBs antigen, as well as smoking, drug and alcohol use for six months before surgery.

Treatment with folk remedies

They are used only in combination, as aids for a general improvement in well-being. No self-treatment!

1. Red rowan fruits: a tablespoon per cup of boiling water, ½ cup three times a day. The amygdalin contained in the berries reduces the sensitivity of cells to hypoxia (reduction of oxygen concentration), swelling decreases due to the diuretic effect, and the vitamin and mineral set has a beneficial effect on the entire body.
2. Adonis (spring), grass: a teaspoon per glass of boiling water, 2 hours to insist, up to 2 tablespoons on an empty stomach, 2-3 times a day. Used as a diuretic, analgesic.
3. Fresh pumpkin juice: half a glass a day. Contains a lot of potassium, useful in certain types of arrhythmias.

Classification and forecast

The classification is based on the principle of functional disorders in PH, the variant is modified and associated with manifestations of heart failure (WHO, 1998):

• Class I: PH with normal physical. activity. Standard loads are well tolerated, mild PH, grade 1 insufficiency.
• Class II: LH plus activity is reduced. Comfortable in a relaxed position, but dizziness, shortness of breath and chest pains begin with normal exertion. Moderate pulmonary hypertension, increasing symptoms.
• Class III: PH with decreased initiative. Problems even at low loads. High degree of blood flow disorders, poor prognosis.
• Class IV: LH with intolerance minimum activity. Shortness of breath, fatigue is felt and in complete rest. Signs of high circulatory failure - congestive manifestations in the form of ascites, hypertensive crises, pulmonary edema.

The prognosis will be more favorable if:

1. The rate of development of PH symptoms is low;
2. The ongoing treatment improves the patient's condition;
3. The pressure in the pulmonary artery system decreases.

Unfavorable prognosis:

1. Symptoms of PH are dynamic;
2. Signs of decompensation of the circulatory system (pulmonary edema, ascites) are growing;
3. Pressure level: in the pulmonary artery more than 50 mm Hg;
4. in primary idiopathic PH.

The overall prognosis for pulmonary arterial hypertension is associated with the form of PH and the phase of the prevailing disease. Mortality per year, with current methods of treatment, is 15%. Idiopathic PH: the survival of patients after a year is 68%, after 3 years - 48%, after 5 years - only 35%.

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A pathological condition, the course of which is characterized by an increase in pressure in the pulmonary artery, is called pulmonary hypertension in medicine. In terms of frequency, the disease ranks third worldwide among vascular diseases characteristic of the elderly.

Causes of Pulmonary Hypertension

Pulmonary hypertension can be either a congenital anomaly, that is, primary, or acquired, which is called secondary.

The following factors may be the reason for the increase in pressure in the arteries of the lungs:

• heart failure;
• vasculitis;
• heart defects of various origins;
• chronic lung diseases, including tuberculosis, bronchial asthma, etc.;
• PE or other lesions of the pulmonary vessels;
• metabolic disorders;
• location in high mountain regions.

In cases where it is not possible to determine the exact causes of hypertension, the doctor makes the diagnosis of primary hypertension. As a disease state of unknown origin, primary pulmonary hypertension may be triggered by various means contraception or result from an autoimmune disease.

Secondary pulmonary disease can be caused by pathologies of the heart muscle, lungs or blood vessels.

Disease classification

Depending on the severity of the course of the disease state, physicians distinguish 4 classes of patients:

1. The first stage, not accompanied by loss of physical activity. A patient with pulmonary insufficiency can withstand normal activities without the appearance of weakness, dizziness, chest pain or shortness of breath.
2. In the second stage of the disease, the patient's physical activity is limited. At rest, there are no complaints, but the usual load causes severe shortness of breath, dizziness and severe weakness.
3. The third stage of hypertension causes the above symptoms with the least physical activity of a person suffering from this disease.
4. Pulmonary hypertension of the fourth stage is marked by pronounced signs of weakness, shortness of breath and pain, even when a person is in a state of absolute rest.

Symptoms of lung failure

The main symptom of the disease is shortness of breath, which has several specific features that make it possible to distinguish it from the symptoms of other diseases:

schematic structure of the vessels of the lungs

• observed at rest;
• its intensity increases with minimal physical activity;
• in a sitting position, shortness of breath does not stop, unlike shortness of breath of cardiac origin.

Other signs of pulmonary hypertension are also characteristic of most patients:

• weakness and fatigue;
• persistent dry cough;
• swelling of the legs;
• pain in the liver area caused by its enlargement;
• pain in the sternum due to the fact that the pulmonary artery expands;
• in some cases, a hoarse voice is observed. This is due to the fact that the artery, when expanded, infringes on the laryngeal nerve.

Thus, pulmonary hypertension, the symptoms of which are often not specific, does not always allow a correct diagnosis to be made without a whole range of examinations.

Diagnosis of the disease

As a rule, patients come to doctors with complaints of severe shortness of breath, which interferes with their daily life. Since primary pulmonary hypertension does not have specific symptoms, allowing you to make a diagnosis with confidence at the first visit to the doctor, the diagnosis should be carried out with the participation of a cardiologist and a pulmonologist.

The complex of procedures involved in the process of making a diagnosis includes the following methods:

• medical examination and history taking. Often the disease is hereditary causes therefore, it is extremely important to collect information about family ailments;
• clarification of the current lifestyle of the patient. Smoking, refraining from physical activity, taking various medications - all this is important in finding out the causes of shortness of breath;
• general inspection. On it, the doctor has the opportunity to identify the physical condition of the veins in the neck, skin color (blue in case of hypertension), enlargement of the liver, the occurrence of edema in the legs, thickening of the fingers;
• electrocardiogram. The procedure allows you to identify changes in the right side of the heart;
• echocardiography helps to determine the rate of passage of blood and the general condition of the vessels;
• CT scan will show, using a layered image, an increase in the pulmonary artery, as well as possible concomitant ailments of the lungs and heart;
• radiography of the lungs will allow you to observe the condition of the artery, its expansion and narrowing;
• the catheterization method is used to reliably measure the pressure inside the pulmonary artery. Doctors consider this procedure not only the most informative for obtaining pressure values, but also associated with minimal risks of complications;
• The 6-minute walk test helps determine physical reaction the patient on the load and set the class of hypertension;
• blood test: biochemical and general;
• angiopulmonography allows, by introducing a special contrast agent into the vessels, to obtain a complete picture of the vessels in the region of the pulmonary artery. The method must be used with extreme caution, since its use can provoke a hypertensive crisis in the patient.

Thus, pulmonary hypertension should be diagnosed only after a thorough comprehensive study of the state of the patient's vessels in order to exclude an erroneous diagnosis.

Reason to see a doctor

The patient should consult a doctor if he feels the following signs of malaise:

• the occurrence or increase in shortness of breath when performing normal daily activities;
• the appearance of pain of undiagnosed origin in the chest;
• if the patient has an inexplicable and persistent feeling of fatigue;
• the appearance or increase in the degree of swelling.

Treatment of pulmonary insufficiency

In most cases, primary pulmonary hypertension is treatable. The main guidelines for choosing a treatment method are:

• identification and elimination of the cause of the patient's condition;
• decrease in pressure in the artery of the lung;
• preventing the formation of blood clots in the patient's vascular system.

When prescribing treatment, the doctor may prescribe the following drugs:

• medications that act to relax muscle layer vessels. This group of drugs is very effective in the initial stages of the disease. Pulmonary hypertension, the treatment of which was started even before vascular changes become pronounced and irreversible, has a very good chances for the complete relief of the patient from symptoms;
• medicines designed to lower the viscosity of the blood. If the blood clotting is very severe, the doctor may decide to bleed. The hemoglobin level in such patients should not exceed 170 g/l;
• with severe shortness of breath and hypoxia, oxygen inhalations are indicated as a means of relieving unpleasant physiological symptoms;
• Your doctor may recommend reducing your salt intake and reducing your fluid intake to 1.5 liters of clean water per day.
• a strict ban on intense physical activity. Only such activity is allowed in which the patient does not feel discomfort and painful manifestations;
• if pulmonary hypertension is accompanied by a complication in the form of insufficiency of the right ventricle of the heart, the doctor prescribes regular intake of diuretic drugs;
• in the most advanced cases of the disease, they resort to a heart and lung transplant procedure. The technique has not yet been sufficiently developed in practical conditions, but the statistics of such transplantations testify to their effectiveness.

Possible Complications

Among the negative consequences of the disease, the main ones can be distinguished:

• exacerbation of heart failure. The right parts of the heart can no longer cope with their current load, which further worsens the patient's situation;
• a condition called PE is a thrombosis of an artery in the lung when a blood clot blocks a vessel. This disease is not only dangerous, but directly threatens the life of the patient;
• hypertensive crisis associated with pulmonary edema.

As a rule, the disease significantly reduces the patient's standard of living and in most cases leads to premature death.

At the same time, pulmonary hypertension causes chronic or acute forms of heart and lung failure, life-threatening for the patient.

Prevention

In order to minimize the risk of this disease, the following measures must be taken:

• adhere to the principles of a healthy lifestyle. In particular, it is necessary to categorically give up smoking and do physical exercises daily;
• it is necessary to timely identify and treat the underlying diseases that entail hypertension. This is possible in the case of regular preventive visits to the doctor;
• with established diseases of the bronchi and lungs of a chronic nature, you need to carefully monitor the course of the disease. Dispensary observation will avoid complications of the disease and facilitate its course;
• diagnosed pulmonary hypertension is not a ban on any physical activity. On the contrary, such patients are shown a moderate exercise in the fresh air. Activity should be regular, but never more intense;
• all situations that entail a stressful state must be excluded. Conflicts at work, at home or in transport can exacerbate the disease.

Thus, the sooner the patient turns to the doctor for advice and the more carefully he follows his instructions, the more likely it is to stop the course of the disease and not transfer it to a more severe stage that is less treatable.

Pulmonary hypertension (PH, pulmonary arterial hypertension syndrome) is an increase in pressure in the pulmonary artery above normal. The disease is not associated with blood pressure - diastolic, systolic. In the case of "usual" hypertension, the treatment of the disease is quite clear and effective. Revealing high blood pressure in the pulmonary artery is not so simple, the disease is difficult to treat.

Classification of the pathological condition

Pulmonary arterial hypertension according to the condition of the cor pulmonale (enlargement of the right heart due to increased pressure in the pulmonary circulation) and right heart catheterization is divided into the following categories:

• disease affecting the left side of the heart (eg, heart defects, valvular defects, long-term heart failure, coronary artery disease);
• disease with dilation of the pulmonary artery and increased flow through it (for example, the disease is a consequence and complication in people with congenital CAP - congenital heart defects, often occurs with atrial septal defect - ASD);
• a disease with disorders of the respiratory system, pulmonary diseases, disorders of the pulmonary capillaries (develops with COPD, pneumoconiosis, pulmonary embolism - PE, systemic connective tissue disease).

Depending on the average pressure in the pulmonary artery, the classification of pulmonary hypertension distinguishes the disease by degree into: mild, moderate and severe.

Standards and phases are presented in the table.

Important! The manifestations of the disease depend on the degree of pulmonary hypertension. first degree ( mild form) is characterized by mild symptoms, (moderate pulmonary hypertension) has more pronounced manifestations. With the most significant signs, the disease poses a great danger to life.

Although systolic pressure values ​​are not significant in determining the diagnosis of primary and secondary pulmonary hypertension, these values ​​can be detected during echocardiography and can significantly help diagnose the disease.

From the point of view of etiology, 2 stages of pulmonary hypertension are distinguished:

• primary pulmonary hypertension;
• secondary pulmonary hypertension.

Primary pulmonary hypertension (idiopathic) develops without known cause mostly in younger women, with small vessel involvement (typical plexiform lesions), telangiectasia (dilation of small vessels).

Hypertension of this nature has a poor prognosis (usually up to 3 years before right-sided heart failure).

Symptoms - dominated by shortness of breath with peripheral cyanosis, chest pain, fatigue.

Secondary hypertension is directly or indirectly associated with another disease.

From the point of view of hemodynamics and pathophysiology (the pathogenesis of pulmonary hypertension plays a role in the classification), it differs:

• precapillary pulmonary hypertension;
• post-capillary hypertension;
• hyperkinetic form of hypertension.

The precapillary form of hypertension is characterized by normal pressure in the left ventricle. As a rule, the disease occurs:

• with pulmonary diseases (COPD, pulmonary fibrosis, sarcoidosis, pneumoconiosis);
• chronic thromboembolic disease (post-embolic pulmonary hypertension);
• with primary damage to the artery;
• after lung resection;
• after hypoventilation.

The cause of postcapillary hypertension is left-sided heart disease (left-sided heart failure, mitral stenosis, hypertrophic cardiomyopathy), constrictive pericarditis.

The basis of hyperkinetic pulmonary hypertension is heart disease:

• atrial defects;
• ventricular septal defects;
• mitral valve prolapse;
• high cardiac output (eg, hyperthyroidism).

In accordance with the timing of the development of hypertension, it is divided into 2 forms:

• acute PH;
• chronic PH.

LH is classified and, in accordance with ICD-10, has the international code I27.0.

Risk factors and causes of PH development

The causative factors are divided into passive (passive pulmonary hypertension develops) and active. Passive ones include the following mechanisms:

• increased pressure in the left atrium;
• vasoconstriction;
• increased blood flow.

Active factors include hypoxemia, which causes spasm of arterioles.

For reasons, primary and secondary forms of hypertension differ. Primary PH occurs "on its own", and the reason for this is the failure of small arteries, which begin to narrow, resulting in high local blood pressure. Most common in adult women, less common in men, adolescents, almost never occurs in children.

Secondary hypertension most often occurs based on the following disorders:

• diseases that impede the flow of blood through the venous system of the lungs (COPD, pulmonary fibrosis, sarcoidosis, silicosis, asbestosis, etc.);
• blockage of arteries by blood clots (thromboembolism);
• long-term overload of the right half of the heart with a large blood flow (for example, in the case of atrial and interventricular septal defects).

The pressure in the lung can be increased with a disorder of the left side of the heart. If the left ventricle is not able to pump enough blood, it begins to accumulate in front of the left atrium in the pulmonary arteries, which will increase the pressure. Pulmonary hypertension often occurs with vasculitis associated with immune-mediated blood vessel disease.

Causes of the disease in children

Relative to the pediatric population, the child is predominantly diagnosed with high pulmonary hypertension, accompanied by a significant acceleration of blood flow.

Newborns are characterized by persistent pulmonary hypertension, the main causes of which are perinatal asphyxia and hypoxia. Less common causes of persistent pulmonary hypertension in newborns are early closure of the arterial duct, resulting in an increase in blood flow.

A relatively common cause of pulmonary hypertension in newborns is diaphragmatic hernia in infants.

Persistent pulmonary hypertension in infants may result from neonatal infection with pathogens.

Pulmonary hypertension in newborns may develop as a result of the use of non-steroidal anti-inflammatory drugs by a woman during pregnancy.

Also, persistent pulmonary hypertension in children is a common consequence of polycythemia (blood flow disorders).

Manifestations of the disease, classes of PH

Doctors distinguish several types of pulmonary hypertension:

• pulmonary arterial hypertension (PAH);
• PH in diseases of the valves, muscles of the left heart;
• PH in lung diseases;
• chronic thromboembolic pulmonary hypertension.

The main signs of pulmonary hypertension:

• shortness of breath (respiratory failure) - most often occurs and manifests itself mainly with exertion, but also during or after eating, in more severe cases, shortness of breath occurs even at rest;
• chest pain - some patients report it as a slight tingling, others - dull or sharp pain, which is often accompanied by palpitations (chest pain is present in ⅓ of patients, but this symptom may be a sign of other cardiovascular diseases);
• dizziness - appears when rising from a bed or chair, in some patients dizziness occurs only in a sitting position;
• fainting - if the brain does not receive enough oxygen for full-fledged activity, a person falls into a temporary unconscious state; fainting can occur with prolonged standing, when blood stagnates in the veins;
• chronic fatigue;
• swelling of the ankles and legs - a very common symptom of hypertension, signaling heart failure;
• dry cough;
• bluish skin color, especially on the fingers and lips, is a condition that signals a low oxygen content in the blood.

For late stages, long high pressure Pulmonary hypertension is also characterized by the following symptoms:

• a person cannot perform the most mundane tasks that are performed in a normal state;
• the patient has symptoms of the disease even at rest;
• the patient during the aggravation of the disease tends to be in bed.

Diagnostics

Doctors use a variety of screening methods to diagnose hypertension. Their goal:

• confirm or exclude the presence of the disease;
• determine the influence of factors contributing to the development of the disease;
• determination, evaluation of the activity of the heart and lungs.

First, the attending physician takes a medical history: asks about signs of lung disease, other diseases, medications taken, about diseases of relatives. Then a detailed examination is carried out.

The following research methods provide assistance in diagnosis:

• electrocardiography (ECG) - evaluates the cardiac load in hypertension;
• blood test - determines how well the blood is oxidized, helps to identify some factors that may contribute to the development of the disease;
• radiology, ultrasound - the radiograph determines the heart rate, pulse rate, the state of the pulmonary arteries is visible on the x-ray;
• pulmonary scintigraphy - shows the supply of blood to the lungs;
• computed tomography (CT) - provides clarification of the image obtained by cardiologists during x-ray examination, ultrasound diagnostics heart and lungs;
• echocardiography is one of the most important methods; on ultrasound of the heart, the presence is detected, the severity of hypertension is assessed;
• spirometry - evaluates airflow in the lungs;
• cardiac catheterization - used to accurately measure blood pressure and blood flow in the lungs.

Therapeutic methods

The propaedeutics of PH is currently not extensive enough, the identification of the causes of the development of the disease continues. Based on the definition of the type of hypertension (by cause), the group and dosage of the drugs used are based. The action of the drugs is aimed at the following results:

• expansion of blood vessels;
• decrease in blood clotting;
• decrease in the amount of fluid in the body due to increased urination;
• improved blood oxygenation.

The most effective therapeutic method is long-term inhalation of oxygen (14–15 hours/day).

Treatment of primary hypertension is very complex. Several compounds are used that cause pulmonary vasodilatation, hence reducing pressure in the pulmonary vasculature. One of these compounds, Sildenafil, is a first-line drug for pulmonary hypertension.

Important! The drug "Sildenafil" showed a strong effect on blood vessels in the penis, which is why its instructions for use indicate a positive effect on potency. Medicines with "Sildenafil" have become popular drugs for erectile support (for example, "Viagra").

Heart failure, usually present in PH, is treated symptomatically. The final solution in certain situations is lung transplantation.

In the secondary form of the disease, treatment of the underlying disease is necessary. If therapy is successful, hypertension is alleviated.

High doses of calcium channel blockers (Nifedipine, Diltiazem, Amlodipine) and nitrates are recommended only if vasoreactivity persists.

Residual pulmonary hypertension (caused by heart defects) involves the use of ACE inhibitors in combination with other drugs.

The use of folk remedies

Simultaneously with medications, you can mitigate the symptoms of the disease with folk remedies. Sometimes they have a similar effect on health, like modern medicines. Folk remedies include:

• ginseng extract;
• barberry extract;
• ginkgo biloba leaf extract.

When used alone, they are unlikely to cure severe disease, but natural remedies have proven their effectiveness over the centuries when used in balanced proportions. Therefore, it is advisable to use them as supportive therapeutic methods for the disease.

Surgical therapeutic methods for PH

With the ineffectiveness of classical therapy, a decision is made on the surgical treatment of pulmonary hypertension. It includes the application of the following methods:

• pulmonary endarterectomy;
• atrial septostomy;
• lung transplant.

Pulmonary endarterectomy

The purpose of the procedure is to remove organized blood clots from the pulmonary artery with part of its wall.

This unique and complex operation is the only treatment option for chronic hypertension due to recurrent pulmonary embolism that can lead to a complete cure for the patient. Prior to the introduction of this method, most patients with this form of the disease died within a few years.

A key part of the operation is performed in deep hypothermia of the patient with complete circulatory arrest.

Atrial septostomy

Septostomy at the atrial level is aimed at improving the indicators of right-sided heart failure in patients with hypertension. This fact follows from an article published by a group of Polish scientists in the April issue professional magazine Chest. Atrial septostomy is used as a temporary treatment while awaiting transplantation or in patients in whom transplantation is not considered, but all therapeutic methods have not been shown to be effective for the disease.

Lung transplantation is a complex operation during which one (both) lungs or the lung-heart complex is displaced from the donor to the recipient. This is the last treatment option for the terminal stages of the disease.

Types of lung transplant:

• unilateral transplantation is usually performed for PH accompanied by COPD, fibrotic diseases, emphysema, bronchiolitis obliterans;
• bilateral transplantation - recommended in the presence of cystic fibrosis, bronchiectasis, histiocytosis;
• transplantation of the "lung-heart" complex - performed in the presence of cardiovascular diseases, primary parenchymal disease associated with myocardial injury or inoperable valve disease.

Important! During the operation, the patient is connected to the extracorporeal blood circulation.

Complications of the procedure

Early complications include bleeding, reperfusion edema, infection present in the donor organ (occurs in approximately 80% of patients), pneumothorax, and cardiac arrhythmias.

A serious late complication is graft rejection. Acute rejection usually occurs within 1 year after surgery. Chronic rejection manifests as obstructive bronchitis.

All transplant patients are immunocompromised, so they are vulnerable to infections.

After transplantation of a donor organ, 70–80% of patients live with this organ for a year, 50–55% for 5 years.

Supportive care

Diuretics relieve congestion symptoms in heart failure. Long-term home oxygen therapy should be continued for at least 15 hours a day (indications for patients with Eisenmenger's syndrome are controversial, usually the procedure is not recommended for this disease).

Chronic anticoagulant therapy ("Warfarin") is indicated primarily for patients with idiopathic hereditary disease to reduce the risk of catheter thrombosis. The INR (international normalization ratio) should be around 2.

After the elimination of the main acute symptoms of a pulmonary disease, it is recommended to maintain a healthy lifestyle (appropriate diet, good rest), prevent exposure to risk factors, sanatorium rehabilitation (for example, treatment in salt mines).

A necessary condition for successful treatment is a change in lifestyle and dietary habits:

• ask your doctor to explain in detail the symptoms of hypertension, contact them immediately if they worsen;
• monitor body weight, consult a doctor immediately if it increases by more than 1.5 kg;
• rest more often, do not overwork;
• do not lift loads weighing more than 5 kg, otherwise blood pressure may increase;
• salt food according to the doctor's instructions;
• get vaccinated against the flu every year;
• do not smoke;
• do not drink alcohol;
• do not take any medications without your doctor's approval;
• pregnancy is extremely dangerous for women - consult your doctor about the appropriate method of contraception.

Prevention and prognosis of the disease

The prognosis of PH without treatment is poor. The median survival for the idiopathic form of the disease is 2.8 years. The median survival for disease with systemic scleroderma is about 12 months. A similar prognosis has a disease associated with HIV infection. In contrast, a better prognosis than idiopathic PH is observed in patients with a disease associated with congenital heart disease.

Prevention of PH is associated with timely diagnosis and treatment of diseases that can lead to the development of hypertension.

Pulmonary hypertension is expressed in an increase in pressure inside the vessels that supply blood to the respiratory system. This entails the development of heart failure, namely, insufficiency of the right ventricle of the heart. As a result, the person dies.

Normally, the pressure in the pulmonary artery is equal to 17-23 mm. rt. Art. With pulmonary hypertension, it will exceed 25 mm at rest. rt. Art. Under load, this figure rises to 30 mm. rt. Art. and more.

Violations that occur in the body with the development of pulmonary hypertension:

Vasoconstriction, which is characterized by vasoconstriction and spasm.

Loss of elasticity of the vascular wall.

The formation of small blood clots inside the vessels of the lungs.

Growth of smooth muscle cells.

Vessel obliteration.

The growth of connective tissue inside the vessels against the background of their destruction.

All this leads to the fact that the blood is no longer able to circulate normally in the vessels of the lungs. During its passage through the arteries, there is an increase in pressure in them. This entails an increase in pressure in the right ventricle, which provokes a violation of its functioning.

A person begins to show signs of respiratory failure, and then symptoms of heart failure join. Even on early stages The development of the disease in a patient significantly worsens the quality of life, which is caused by the impossibility of normal breathing. As the pathology progresses, a person has to more and more restrict himself in physical activity.

Pulmonary hypertension is a serious disease that claims the lives of people. If the patient does not receive adequate therapy, then he will not live longer than 2 years. At the same time, he will need outside help for life support. Pulmonary hypertension can and should be treated, but a complete recovery cannot be achieved.

The detection and treatment of pulmonary hypertension is the task of the therapist, pulmonologist, cardiologist, geneticist and infectious disease specialist, that is, doctors of several specialties. If necessary, vascular and thoracic surgeons are involved in therapy.

The disease begins to develop imperceptibly for a person. Pathological processes at the initial stage are hidden, as the body includes compensatory mechanisms. Therefore, the patient feels well.

When the pressure in the pulmonary arteries exceeds 25 mm. rt. Art., a person begins to notice deterioration in health. However, they appear only during physical activity. As the pathology progresses, the patient will experience more and more difficulties during the performance of even the most familiar activities.

The main symptoms of pulmonary hypertension are:

Shortness of breath, which occurs as the first manifestation of the disease. At first, it appears only during physical effort, it worries a person on inspiration. In the future, shortness of breath will be present on an ongoing basis, even when the patient is at rest. He does not suffer from asthma attacks.

Pain in the sternum. Their nature varies, the pains can be aching, pressing, stabbing. A person cannot accurately tell the doctor about the time of manifestation of pain, however, he notes that they become more intense during physical effort. Nitroglycerin does not eliminate the pain syndrome.

Damage to the interstitium of the lungs as a result of the growth of connective tissue or against the background of an inflammatory disease.

Thus, the following risk factors that can lead to the development of the disease can be distinguished:

Taking medications, getting into the body of toxic substances. It has been established that pulmonary hypertension may occur while taking Fenfluramine, Rapeseed oil, Aminorex, Dexfenfluramine. Scientists also suggest that substances such as amphetamine and L-tryptophan can provoke pathology.

Demographic risk factors and medical factors. It has been proven that women are more likely to suffer from pathology. It is also believed that hypertension may be associated with high blood pressure and pregnancy.

Some diseases. The relationship between PAH and HIV infection has been established. Pulmonary hypertension may develop in liver pathologies.

Degrees of pulmonary hypertension

There are four degrees of pulmonary hypertension, which determine the severity of the course of the disease:

The first degree is characterized by the absence of any symptoms.

The second degree is manifested by all the symptoms of the disease, which are described above. At the same time, their intensity is extremely low, the patient does not complain. Pathological manifestations will disturb a person only during physical activity.

The third degree of the disease is manifested by a deterioration in well-being even against the background of slight physical exertion. At rest, the patient feels normal.

The fourth degree of the disease is expressed in the fact that it is difficult for a person to perform even elementary actions. Symptoms of pulmonary hypertension do not go away during a state of complete rest.

If a person suspects that he is developing pulmonary hypertension, he should see a doctor.

Doctor will hold complex diagnostics, which boils down to executing next events:

Examination of the patient. During initial examination the doctor can detect cyanosis of the skin on the upper and lower extremities. The patient's nails may be thickened, have the shape of "drum" sticks. If the patient has emphysema, then his chest will be expanded like a "barrel". The liver is often enlarged, which is noticeable on palpation. It is possible to identify ascites and pleurisy, in which fluid accumulates in the peritoneal cavity and in the pleura. The patient's legs are swollen, the veins in the neck are dilated.

Listening to the heart and lungs. Above the pulmonary artery, the noises are increased by 2 tones, characteristic single wheezing is heard. With valvular heart failure, systolic murmurs will be heard. It is possible to listen to noises that characterize heart disease, if any.

In 55% of cases, the diagnosis allows you to perform an ECG. 87% have an enlarged right ventricle with thickened walls. The load on the right parts of the heart increases significantly, which can be determined by the corresponding signs. To the right, the electrical axis of the heart deviates in 79% of people.

Vector electrocardiography can detect pulmonary hypertension in 63% of cases. As for the indicators, they change similarly to the ECG indicators.

Phonocardiography, which allows you to record heart murmurs, which increases the probability of making a correct diagnosis, at least up to 76%. At the same time, it is possible to detect an increase in pressure in the pulmonary artery, changes in the structure of the right ventricle, congestion in the pulmonary circulation, and malformations of the heart.

X-ray examination chest allows you to detect bulging of the pulmonary artery, expansion of the roots of the lungs, the right heart becomes larger in size. The edges of the lungs are characterized by increased transparency.

Ultrasound of the heart or ECHOCG makes it possible to detect an increase in pressure in the trunk of the pulmonary artery, to identify abnormalities in the work of the tricuspid valve and the interventricular septum. Also, studies make it possible to detect malformations of the heart, expansion of the right heart, thickening of the walls of the right ventricle.

The introduction of the device into the heart through large veins (catheterization of the right heart). This invasive procedure allows you to determine the pressure in the pulmonary artery and in the ventricle, the level of oxygenation of the blood, disorders in the blood circulation of the ventricle of the heart and lungs. In parallel, drug tests can be performed that allow you to find out the body's response to calcium antagonists. These drugs are the main ones in the treatment of pulmonary hypertension.

If the listed research methods are not enough to make a correct diagnosis, then the doctor will refer the patient to additional examinations, including:

FVD - definition of function external respiration. This method allows to exclude pathologies of the respiratory system. If the pressure in the pulmonary artery system is increased, then the doctor diagnoses a decrease in the partial pressure of oxygen and carbon monoxide.

Carrying out ventilation-perfusion lung scintigraphy. During the study, the doctor injects radioactive particles into the bloodstream that reach the lungs. This makes it possible to detect thrombotic masses in the pulmonary artery system.

Multislice computed tomography of the lungs and heart with the introduction of contrast. This method allows you to create a three-dimensional model of the respiratory organs and display them on the screen. As a result, the doctor receives maximum information about the disease.

Angiopulmonography. During the study, a contrast agent is injected into the pulmonary vessels, and then a series of images are taken on x-ray machines. This study allows you to detect blood clots in the arteries.

The prognosis of pulmonary hypertension is poor. It will not be possible to achieve a complete recovery. If the patient receives treatment, then heart failure, leading to death, will still occur, but the patient will still be able to prolong life.

If the cause of pulmonary hypertension is systemic scleroderma, then the prognosis is as unfavorable as possible. When the disease occurs, the degeneration of normal organ tissue into connective tissue occurs. As a result, a person dies within the first year.

In idiopathic pulmonary hypertension, the prognosis improves slightly. Such patients can live, on average, three years after diagnosis.

If it leads to pulmonary hypertension, then the patient is sent for surgery. The five-year survival rate of such patients is equivalent to 40-44%.

If, against the background of pulmonary hypertension, heart failure rapidly increases with damage to the right ventricle of the heart, then a lethal outcome will occur within 2 years after the manifestation of the disease.

If pulmonary hypertension has an uncomplicated course and is amenable to medical correction, then about 67% of patients cross the line of 5 years.

Treatment of pulmonary hypertension can be either conservative or surgical. Full recovery does not occur. If the human body perceives the ongoing therapy, then this helps to improve its overall well-being. A person is able to perform physical work. Life expectancy can be increased by 2 times.

To alleviate the course of the disease, as well as improve the quality and life expectancy, it is necessary to adhere to the following recommendations:

Physical activity should be limited. This rule must be observed especially strictly immediately after eating, and also if you are in a too cold or too hot room.

Physical activity should be regular, but complexes should be made only on the basis of medical indications. This allows not to burden the heart and lungs, but to maintain adequate vascular tone.

When traveling by plane, you need to use oxygen therapy.

It is necessary to prevent various diseases of the respiratory system.

It is necessary to stop taking hormonal drugs during menopause.

You should stop taking hormonal drugs to prevent unwanted pregnancy.

It is necessary to monitor the level of hemoglobin in the blood.

Medication is the main treatment for pulmonary hypertension. For therapy, several medications by combining them with each other.

Drugs that a person will receive throughout life:

Antiplatelet drugs that prevent the formation of blood clots. The main representative of this drug group- Aspirin.

Anticoagulant drugs, which thin the blood, make it less viscous, which is also aimed at preventing the formation of blood clots. Medicines of this group are Heparin and Warfarin.

Cardiac glycosides that contribute to the normal functioning of the heart muscle. For this purpose, the patient is prescribed Digoxin.

Calcium antagonists are drugs that are used for the main treatment of the disease. Their use is aimed at expanding the small vessels of the lungs. The main representatives of this group are: Diltiazem and Nifedipine.

Courses are also treated with the following drugs:

Prostaglandin E and Treprostinil are drugs that are aimed at preventing the formation of blood clots, as they do not allow the blood to become viscous, while expanding the lumen of the vessels.

Bosentan is an endothelial receptor antagonist. The drug is aimed at removing vascular spasm from the small arteries of the lungs, and also prevents their cells from carrying out pathological growth.

Sildenafil is a phosphodiesterase inhibitor drug. This drug helps to relieve spasm from the vessels of the lungs and reduces the load on the right ventricle of the heart.

Oxygen therapy allows you to saturate the blood with oxygen. This is especially true in adverse conditions. external environment, or with a sharp deterioration in the patient's well-being. It is also possible to perform inhalations with nitric oxide, which are performed in a hospital ward. This procedure allows you to expand the vessels and alleviate the patient's condition.

If a drug correction does not allow to achieve the desired effect, the patient is sent for surgery. It is indicated when the cause of pulmonary hypertension is heart disease.

Depending on the disease, various surgical techniques can be applied, including:

Atrial septostomy. This method allows you to establish communication between the atria. It is recommended for those patients who suffer from right ventricular failure. Septostomy is used as a preparation for a patient before a heart or lung transplant operation.

Thrombandarterectomy. This procedure is aimed at removing blood clots from the pulmonary arteries. The operation allows you to reduce the load on the heart, make the symptoms of the disease less pronounced. The procedure will be performed only on the condition that the thrombotic masses have not yet begun to degenerate into connective tissues.

Organ transplantation. Lung and heart transplants are possible. The complexity of the operation makes it rare.

Modern drugs

Macitentan is a drug belonging to the group of endothelial receptor antagonists. It is prescribed as an antihypertensive agent, that is, to lower blood pressure in patients with pulmonary hypertension.

The drug is recommended for the treatment of idiopathic pulmonary hypertension, for the treatment of PAH, which develops against the background of heart disease and against the background of connective tissue pathologies. The drug is aimed at relieving the symptoms of the disease and improving the quality of life of patients.

Macitentan reduces the risk of hospitalization associated with pulmonary arterial hypertension by 51.6%. The cost of the drug is quite high and is equal to 2800 euros.

Ventavis is a solution for inhalation, in which the main active ingredient is iloprost. Ventavis is a drug with antiplatelet properties. It prevents the formation of blood clots in the pulmonary arteries by inhibiting platelet aggregation.

Another effect of the use of the drug Ventavis is a vasodilating effect on the arteries of the lungs. That is, the drug expands their lumen, thereby relieving the load from the heart muscle.

Ventavis is the only inhalation drug from the prostanoid group that is available in the Russian Federation. It is inhaled 6 to 9 times a day using a nebulizer.

Ventavis therapy has a proven effectiveness, which has been confirmed in the course of scientific studies. They included 203 patients with PAH who received monotherapy with the drug for 12 weeks. This reduced dyspnea and improved NYHA functional class in 16.5% of patients. The average increase in 6-MX distance during treatment was 36.4 m.

Also, the drug can be used as a drug in the complex therapy of pulmonary arterial hypertension. The STEP study on this issue lasted 12 weeks and included 67 patients with PAH. The therapy was supplemented with Bosentan. It was found that patients had a significant increase in physical performance, and other symptoms of the disease began to decline.

The Opitiz study involved 6 people who received the drug for 5 years. At the same time, the survival rate of people increased from 32% to 49% compared with patients who did not receive similar treatment.

The AIR 1 study was also conducted, in which people received therapy for one year and three years. Survival rates were 83% at 1 year, 78% at 2 years, and 58% at 5 years.

Therefore, it can be argued that the drug not only improves the quality of life of patients with PAH, but also prolongs it. At the same time, the cost of Ventavis is about 100,000 rubles per pack.

Tracleer is a drug whose main active ingredient is bosentan. The drug is produced in the form of tablets. Its main effect is the expansion of the pulmonary arteries, by removing vascular resistance from them. This allows you to reduce the load on the heart, reduce, improve the well-being of patients and increase the body's tolerance to physical exertion.

With this drug, you can increase life expectancy in patients with idiopathic PAH, as well as with secondary PAH. Traklir is prescribed to patients with pulmonary hypertension against the background of heart defects. It can be used for both adults and children.

The cost of the drug is 200,000 rubles per package.

Revacio is a prescription drug, the main active ingredient of which is sildenafil. The leading effect of taking the drug is the removal of spasm from the pulmonary arteries, as well as the expansion of their lumen. In addition, Revatsio allows you to reduce blood pressure, reduce the load on the heart muscle. The patient's body becomes tolerant to physical exertion, even if pulmonary arterial hypertension is severe. It has been proven that the drug improves the survival of patients with PAH.

Revatio can be used in a complex treatment regimen for pulmonary hypertension. It is used to treat all forms of the disease. average price for the package of the drug is 50,000 rubles.

Volibris is a drug from the group of endothelin receptor antagonists. Its main active ingredient is Ambrisentan. Taking the drug can reduce the clinical symptoms of pulmonary arterial hypertension, increase the level of exercise tolerance, and improve hemodynamic parameters. The effect of the use of the drug Volibris is stable during the year.

The average price for a package of a medicinal product is 60,000 -75,000 rubles.

The drug Adempas with the main active ingredient Riociguat. This drug belongs to the pharmacological group of antihypertensive drugs, guanylate cyclase stimulants.

Taking the drug Adempas can reduce pulmonary vascular resistance, improve hemodynamics, reduce the severity of shortness of breath, reduce the clinical manifestations of the disease. The drug used in complex therapy makes it possible to increase the one-year survival rate of patients up to 96%. The drug is prescribed to patients with PAH, accompanied by the formation of blood clots, with idiopathic, hereditary PAH and with PAH associated with connective tissue pathologies.

Aptravi (Selexipag)

Aptravi is a selective non-prostanoid prostacyclin receptor agonist. It should be noted that the drug is not registered in Russia. Its main effect is the expansion of spasmodic pulmonary vessels and lowering blood pressure. The drug is used in a complex treatment regimen for PAH, as well as as an independent remedy. The average cost of one package of Aptravi is equal to 5200 euros.

Pulmonary hypertension (PH) is a disease in which pressure in the pulmonary artery increases. Normally, systolic pressure in the pulmonary circulation should be 18-25 mm Hg, diastolic - 6-10 mm Hg, and the average specific pressure - within 12-16 mm Hg. The diagnosis of "pulmonary hypertension" is made if the average specific pressure exceeds 30 mm Hg. during physical activity and 25 mm Hg. at rest.

This disease significantly worsens the patient's condition and has an unfavorable prognosis.. In some cases, it develops slowly, so patients may long time be unaware of having pulmonary hypertension and start treatment at a late stage. But remember that in any case, not everything is lost: if you have been diagnosed with this disease, you can improve your condition thanks to special folk remedies. They reduce pressure in the pulmonary artery and relieve unpleasant symptoms.

Stages of pulmonary hypertension

So, we know what LH is, now it's time to talk about its stages. Based on the pressure measured in the pulmonary artery, the disease is divided into three groups:

• mild pulmonary hypertension - corresponds to an average specific pressure of 25-36 mm Hg;
• moderate pulmonary hypertension - pressure is 35-45 mm Hg;
• severe pulmonary hypertension - pressure exceeds 45 mm Hg.

Naturally, the higher the severity of the disease, the worse its prognosis.

Causes and types of pulmonary hypertension

The cause of PH is a steady increase in pressure in the pulmonary vessels. This may be due to the following factors:

• heart disease, valvular disease (mitral regurgitation) or Eisenmenger's syndrome with congenital anomalies;
• lung diseases such as pneumoconiosis (COPD), sleep apnea syndrome;
• connective tissue diseases such as systemic lupus erythematosus, etc.;
• complications after pulmonary embolism;
• other diseases that damage the pulmonary vessels (HIV infection, portal hypertension, poisoning with toxic drugs).

Pulmonary hypertension in terms of causes of occurrence is divided into 4 groups:

• pulmonary arterial hypertension - mainly caused by connective tissue diseases, HIV - infection, portal hypertension, heart defects;
• venous pulmonary hypertension - develops as a result of diseases of the left valve or left ventricle of the heart;
• pulmonary hypertension associated with respiratory diseases or hypoxia - mainly appears due to interstitial lung disease, COPD, breathing disorders during sleep, chronic mountain sickness;
• pulmonary hypertension associated with chronic thromboembolism - caused by blockage of the pulmonary arteries.

Primary pulmonary hypertension

The primary form is also sometimes referred to as idiopathic pulmonary hypertension. It occurs rarely (about 2 cases per million people), its etiology is unknown. The disease is more often diagnosed in middle-aged women. Risk factors, in addition to the above, are a family history of hypertension, infectious diseases, and portal hypertension.

Primary pulmonary hypertension occurs with vasospasm in the pulmonary circulation. In this case, excessive blood clotting is observed. The prognosis is very unfavorable. However, if you have been diagnosed with primary pulmonary hypertension, do not despair. Better pull yourself together and start treatment with folk remedies - this will help prolong life for many years.

Secondary pulmonary hypertension

It develops against the background of other diseases - bronchial asthma, heart defects, pulmonary fibrosis, hypertension, systemic lupus erythematosus, etc. Thus, in order to get rid of PH, you must first cure the primary disease, if possible.

Symptoms

The first signs of pulmonary hypertension are a feeling of continuous fatigue and difficulty breathing, especially after exercise. Patients have difficulty walking, climbing stairs, bending over, and doing normal housework.

In the later stages of the disease, the following symptoms appear:

• dry cough;
• hoarseness;
• chest pain;
• hemoptysis;
• bluish tint of lips;
• fainting;
• cold extremities.

Pulmonary hypertension in newborns is manifested by retraction of pliable places on the chest, shortness of breath and severe cyanosis of the skin. In this case, oxygen treatment does not give any results.

Forecast and consequences

Any kind of PH gives the same result: increased pulmonary vascular resistance. These conditions force the right ventricle to work harder, resulting in cardiac hypertrophy and dilatation within the right ventricle. As a result, congestive heart failure and mitral valve insufficiency develop. Excessive overload of the right ventricle due to lung disease is called cor pulmonale. These changes lead to a decrease in cardiac output, and if the disease is not treated, then to death.
The prognosis depends on the neglect of PH. If you take care of yourself, follow some recommendations and carry out treatment, you can stop the development of the disease.

Treatment

So, you already know what pulmonary hypertension is and what are its symptoms. Now it's time to consider treatment.

Palliative care if you have idiopathic (primary) pulmonary hypertension, which allows you to extend the life of the patient and improve its quality. With secondary pulmonary hypertension, the diseases that led to such a problem are eliminated.

Below we will give lifestyle advice to patients and present folk remedies that reduce pressure in the pulmonary artery.

Diet and lifestyle

Patients should avoid situations in which the symptoms of the disease worsen. Give up physical effort, do not climb to great heights, do not fly in airplanes. If the state of health deteriorates, breathing through oxygen cylinders can be used.

It is very important to try to avoid stress, as it increases blood pressure and heart rate. To combat stress, use meditation, walking in the fresh air, meeting friends, hobbies, and other appropriate ways.

When it comes to diet, the main rule here is to reduce salt intake. Replace it with other spices. Also, patients should drink no more than 1.5 liters of water per day, so as not to increase the pressure. Naturally, alcohol and cigarettes with such a disease are completely prohibited.

Garlic

A mild subspecies of pulmonary hypertension can be completely cured with garlic. The fact is that this product expands the vessels of the pulmonary circulation, removes congestion in the veins, thereby reducing pressure. It is also very good for the heart, and it is heart problems that often lead to PH.

The simplest recipe is to eat 2 cloves of garlic every morning on an empty stomach with a glass of water. If you are afraid bad smell out of your mouth, chew the garlic with a mint leaf.

Garlic tea helps a lot. Don't let such an exotic name scare you - such a drink is very tasty and healthy. It will help restore not only the circulatory and respiratory system, but the entire body. Ingredients per serving:

• 1 clove of garlic;
• 1 glass of water;
• a little ground ginger (about 7-8 grams);
• 1 tablespoon lemon juice;
• 1 tablespoon honey.

Put water on fire. When it begins to boil, add the pre-minced garlic clove, ginger and a spoonful of honey. Mix everything well and leave to cook on low heat for about 20 minutes. Then strain the resulting infusion. At the end, add some lemon juice. We recommend drinking this tea on an empty stomach twice a day.

Clover

Clover is very good for the cardiovascular system and will help with your disease. It can be used in many different ways.

If possible, plant clover in a pot at home, and eat the young sprouts of this plant. A tablespoon of herbs will suffice.

You can also make tea from dried clover flowers. For a glass of water, you need a teaspoon of the crushed plant. Pour boiling water over clover, leave for 15 minutes, then drink. Take 2-3 glasses of this drug per day.

Digitalis

Digitalis will save you from pain in the chest and severe shortness of breath, but you need to drink it carefully, increasing the dosage and monitoring the state of the body.

Prepare an alcohol tincture at the rate of 1 part of dry foxglove herb to 10 parts of alcohol with a strength of 70 degrees. Infuse the mixture for 2 weeks, then strain. Start with a dosage of 3 drops twice a day. The tincture should be dissolved in a small amount of water and drunk on an empty stomach. After about a week, the dosage can be increased to 5 drops, then after another week - up to 7 drops. Then move on to 10 drops of the tincture twice a day. The course of treatment lasts from 2 to 4 months.

Hawthorn

Hawthorn dilates blood vessels, helping to reduce systolic and diastolic pressure in the pulmonary artery. It can be used in several ways.

The first way is tea. To prepare a drink, pour a dessert spoon of dried hawthorn flowers and leaves into a mug and pour a glass of boiling water. Keep the glass covered for 15 minutes, then strain the drink. It should be drunk 1 glass in the morning and evening.

The second method is healing wine. You will need 50 g of ripe hawthorn fruit and 500 ml of natural red sweet wine. Crush the berries in a mortar, heat the wine to a temperature of about 80 C. Pour warm wine into a glass jar or bottle, add hawthorn, close the lid and leave for 2 weeks, then strain. Drink 25 ml of this wine every night before bed.

Method three - alcohol tincture. Combine hawthorn flowers with alcohol in a ratio of 1 to 10 and infuse in a glass container for 10 days, then strain. Drink about half a teaspoon of this tincture in the morning and evening on an empty stomach.

mistletoe

It will be much easier for the patient if he starts taking mistletoe. In the evening, pour a teaspoon of herbs into a glass cold water, let the mixture infuse overnight. Warm it up a little in the morning and drink it. This is how you should do it every day.

You can also make wine from mistletoe. You will need 50 g of the plant and 500 ml of dry white wine. Combine these ingredients and infuse for 1 week, then strain. Take 25 ml twice daily before meals.

rowan fruits

The fruits of mountain ash have a beneficial effect on the cardiovascular system. Therefore, replace ordinary tea with tea from this plant. Mash a tablespoon of fruits in a mug, add a small amount of sugar and 200 ml of boiling water. Stir and drink. It is recommended to take 3 servings of this tea per day.

Witch Doctor Collection

There is a good collection of plants recommended by experienced healers. Combine in equal parts adonis herb, valerian root, mint leaves, St. John's wort and dill seeds. At night in a thermos, brew a tablespoon of this mixture with a liter of boiling water and insist until morning. This will be your serving for the whole day, you need to drink the infusion in between meals. Continue the course of treatment for 2 months, then you need to take a break for at least 2 weeks.

Treatment with juices and smoothies

Juice is a natural healer that will help to cope with many problems, including PH. We will give some of the most effective recipes.

Juice for the heart

With pulmonary hypertension, you need to support the work of the heart. To do this, prepare this mix:

• 2 glasses of red grapes;
• 1 grapefruit;
• 1 teaspoon crushed linden flowers;
• ¼ teaspoon powdered cloves

Combine all these ingredients and mix in a blender. You need to drink smoothies immediately after preparation, it is recommended to take a glass a day. Within weeks, you will notice positive changes.

Juice to normalize pressure

Connect the following components:

• juice of 1 grapefruit;
• juice from 2 oranges;
• 6 sprigs of fresh parsley;
• 2 tablespoons of hawthorn flowers;
• 3 kiwis, peeled and chopped

Mix everything in a blender and drink immediately after preparation. Take this remedy in the morning and in the evening so that the arterial and pulmonary pressure is always normal.

Juice for shortness of breath

If shortness of breath is tortured, conduct a monthly course of treatment with this juice:

• 5-6 fresh dandelion leaves;
• 1 tablespoon of red clover flowers;
• 1 red apple;
• 1 cup shredded Brussels sprouts;
• 1 large carrot;
• 0.5 cup chopped parsley

Squeeze juice from apple, carrot and Brussels sprouts, mix juices, add parsley, red clover and finely chopped dandelion leaves. Take juice on an empty stomach, 1 glass twice a day.

Juice for general well-being

You will need:

• half a melon;
• 1 glass of fresh strawberries;
• a piece of ginger root 2.5 cm long;
• 1 orange;
• 1 grapefruit;
• ¼ cup natural yogurt (no additives)
• half a handful of wheat germ.

Squeeze juice from orange, melon, strawberry and grapefruit. Grate the ginger. Combine juices, add ginger, yogurt and wheat germ. Drink to your health!

Kolesnik Inna Iosifovna, family doctor, Tallinn

Pulmonary hypertension (PH) is characteristic of diseases that are completely different both in terms of their causes and defining features. LH is associated with the endothelium (inner layer) of the pulmonary vessels: growing, it reduces the lumen of arterioles and disrupts blood flow. The disease is rare, with only 15 cases per 1,000,000 people, but survival is very low, especially in primary PH.

The resistance in the pulmonary circulation increases, the right ventricle of the heart is forced to increase contractions in order to push blood into the lungs. However, it is not anatomically adapted to long-term pressure loading, and with PH in the pulmonary artery system, it rises above 25 mm Hg. at rest and 30 mmHg during exercise. First, in a short period of compensation, there is a thickening of the myocardium and an increase in the right parts of the heart, and then a sharp decrease in the strength of contractions (dysfunction). The result is premature death.

Why does PH develop?

The causes of the development of PH have not yet been finally determined. For example, in the 60s in Europe there was an increase in the number of cases associated with the excessive use of contraceptives and weight loss agents. Spain, 1981: Complications of muscle damage following the popularization of rapeseed oil. Almost 2.5% of 20,000 patients were diagnosed with arterial pulmonary hypertension. The root of evil was the tryptophan (amino acid) present in the oil, this was scientifically proven much later.

Violation of the function (dysfunction) of the endothelium of the vessels of the lungs: the cause may be hereditary predisposition, or the influence of external damaging factors. In any case, the normal balance of nitric oxide metabolism changes, the vascular tone changes towards spasm, then inflammation, endothelial growth and a decrease in the lumen of the arteries begin.

An increase in the content of endothelin (vasoconstrictor): caused either by an increase in its production in the endothelium, or by a decrease in the breakdown of this substance in the lungs. It is noted in the idiopathic form of PH, congenital heart defects in children, systemic diseases.

Violation of the synthesis or availability of nitric oxide (NO), a decrease in the level of prostacyclin production, additional excretion of potassium ions - all deviations from the norm lead to arterial spasm, proliferation of the muscular wall of blood vessels and endothelium. In any case, the final development is a violation of blood flow in the pulmonary artery system.

Signs of the disease

Moderate pulmonary hypertension does not give any severe symptoms, this is the main danger. Signs of severe pulmonary hypertension are determined only in the later periods of its development, when pulmonary arterial pressure rises, compared with the norm, by two or more times. The norm of pressure in the pulmonary artery: systolic 30 mm Hg, diastolic 15 mm Hg.

Initial symptoms of pulmonary hypertension:

• Unexplained shortness of breath, even with little physical activity or at complete rest;
• Gradual weight loss even with a normal, nutritious diet;
• Asthenia, constant feeling of weakness and impotence, depressed mood - regardless of the season, weather and time of day;
• Persistent dry cough, hoarse voice;
• Discomfort in the abdomen, a feeling of heaviness and "bursting": the onset of stagnation of blood in the system that conducts venous blood from the intestines to the liver;
• Dizziness, fainting - manifestations of oxygen starvation (hypoxia) of the brain;
• Rapid heartbeat, over time, the pulsation of the jugular vein becomes noticeable on the neck.

Later manifestations of PH:

1. Blood-streaked sputum and hemoptysis: signal increasing pulmonary edema;
2. Seizures (chest pain, cold sweat, fear of death) - a sign
3. (cardiac arrhythmias) by the type of ciliated.

Pain in the hypochondrium on the right: the systemic circulation is already involved in the development of venous stasis, the liver has enlarged and its shell (capsule) has stretched - therefore, pain has appeared (the liver itself does not have pain receptors, they are located only in the capsule)

Edema of the legs, in the region of the legs and feet. Accumulation of fluid in the abdomen (ascites): manifestation, peripheral, decompensation phase - a direct danger to the patient's life.

Terminal stage of HT:

• Thrombi in the arterioles of the lungs lead to the death () of active tissue, an increase in suffocation.

Currently answering questions: A. Olesya Valerievna, candidate of medical sciences, lecturer at a medical university

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