Pulmonary Hypertension: Causes, Symptoms and Treatment

Pulmonary hypertension (PH) is a serious condition of the blood vessels in the lungs: the blood pressure there is higher than normal.

The heart pumps blood through the pulmonary arteries to the lungs, where it picks up oxygen, then back to the heart, which sends it out to the body's tissues. If the pulmonary arteries are damaged, narrowed or blocked, blood flows through them less easily, pressure in them rises, and pulmonary hypertension results. There are several types, including pulmonary arterial hypertension (PAH), defined by what caused the disease.

Causes

PH can develop on its own or result from another condition, and sometimes the cause is unknown or unclear. Possible causes:

• heart disease, including left-sided heart failure and congenital heart disease;
• lung disease, such as COPD, interstitial lung disease, emphysema and sleep apnea;
• other conditions: liver disease, sickle cell disease, pulmonary embolism (blood clots in the lungs), and connective tissue disorders such as scleroderma.

Who is at risk

Symptoms

Symptoms can be hard to recognize and resemble other conditions, so diagnosis sometimes takes years. They may include:

• shortness of breath;
• chest pain or pressure;
• dizziness, sometimes to the point of fainting;
• fatigue;
• swelling of the abdomen, legs or feet;
• heart palpitations — a pounding or racing heartbeat.

Complications

PH can worsen over time and lead to anemia, heart rhythm problems (arrhythmias), blood clots in the pulmonary arteries, bleeding in the lungs, heart failure, liver damage, fluid around the heart (pericardial effusion) and serious complications in pregnancy.

Diagnosis

A provider will ask about medical history and symptoms and do a physical exam — checking blood oxygen, listening to the heart and lungs, and taking blood pressure — and will likely order tests:

• blood tests for blood clots, strain on the heart or anemia;
• heart imaging, such as cardiac MRI;
• lung imaging, such as a chest X-ray;
• an electrocardiogram (ECG or EKG).

Treatment

There is often no cure, but treatment can manage symptoms. The plan depends on the person's needs and the cause, and may include:

• lifestyle changes: healthy eating with less salt, and regular physical activity, possibly through pulmonary rehabilitation;
• medicines: blood thinners, drugs to control the rate at which blood is pumped through the body, drugs that relax blood vessels so blood flows better, and diuretics to reduce swelling;
• oxygen therapy;
• procedures to lower pressure in the heart or pulmonary artery;
• in some severe cases, a lung transplant.

Sources

Based on the MedlinePlus health topic "Pulmonary Hypertension," National Library of Medicine, with a summary from NIH's National Heart, Lung, and Blood Institute; a work of the United States government in the public domain.