Pulmonary Artery Hypertension - Pulmonary Aterial Hypertension Overview

Covering pulmonary artery hypertension definition, causes, symptoms, treatment and medications and in pregnancy

Hypertension affects millions of people globally and is a raising problem. The causes of hypertension in general are not fully known as is the case with essential hypertension. Hypertension is a broad condition with is comprised of various types and subtypes such as malignant hypertension, morning hypertension, isolated systolic hypertension, isolated diastolic hypertension, labile hypertension and pulmonary hypertension and all its subtypes including pulmonary arterial hypertension and others.

Pulmonary Artery Hypertension Definition

Pulmonary arterial hypertension the subject of this article is a progressive and ultimately fatal disorder which largely presents known specific symptoms. It is characterized by abnormally high blood pressure in the blood vessels that carry blood from the heart to the lungs medically known as the pulmonary arteries. It is a relatively common disorder especially in females and up to 1000 cases are identified each year in America alone.

A mean arterial high blood pressure of 25mm Hg in the context of other underlying associations including response to treatment also points to pulmonary arterial hypertension. In order to be managed effectively timely recognition of the disorder, accurate diagnosis and appropriate selection of hypertension medications or therapeutic alternatives is of paramount importance.

Pulmonary Artery Hypertension Causes

Some credible studies have pointed to the causes of the disorder being hereditary. These studies have shown that some 6% of pulmonary hypertension patients had first-degree relatives (a family member sharing about 50 percent of their genes with a particular individual in a family) who also had pulmonary arterial hypertension. When the disorder is inherited it is known as familial pulmonary arterial hypertension.

Illicit use of methamphetamine and its derivatives a highly addictive central nervous system stimulant also used in appetite suppressants such as those used in the treatment of obesity has been shown to increase the future prevalence of toxic pulmonary arterial high blood pressure.

Decreased partial pressure of oxygen in the blood also known medically as hypoxemia has been associated with pulmonary artery hypertension specifically due to its vasoconstrictive stimulus which is the narrowing of blood vessels which in turn increases blood pressure. Heart disease may in itself result in high blood pressure in lung arteries as much as airways diseases which must be treated.

Pulmonary Artery Hypertension Symptoms

Hypertension symptoms are generally the same in hypertension patients but also tend to present specific known ones in particular high blood pressure subtypes. The leading and most frequently presenting pulmonary arterial hypertension symptom in a typical pulmonary arterial high blood pressure patient is breathlessness on exertion known medically as dyspnea. This makes it very difficult for patients to carry out any meaningful physical activity.

A significant number of patients yet experience angina a medical term which refers in layman's terms to chest pain or chest discomfort during the course of the disease. Chest pains may develop due to the following specific reasons;

  • Progressive right ventricular stress of the heart resulting in elevated heart demand for oxygen known medically as myocardial oxygen demand
  • Critically elevated right ventricular (heart) systolic blood pressure
  • Development of concomitant atherosclerotic coronary artery disease
  • Compression of the left main coronary artery by the dilated main pulmonary artery

Temporary loss of consciousness and posture also known medically as syncope is yet another symptom occurring in approximately 30% of pulmonary artery hypertension patients. There are other general pulmonary hypertension symptoms that might occur in patients and not necessarily discussed above.

Pulmonary Artery Hypertension Treatment and Medications

There is currently no cure for pulmonary arterial high blood pressure. Current treatment goals are aimed at reducing pulmonary vascular resistance, pressure and symptoms to increase patient activity, comfort and lifespan. In that regard in the last decade or so there has been remarkable development of effective treatments that have enhanced the outcome for patients.

Prior to these developments of effective treatment regimen pulmonary artery high blood pressure patients had a median life expectancy of just about 2.8 years. This has now improved significantly.

Doctors use six main approaches to treatment of pulmonary arterial high blood pressure. The first approach is prevention. Preventing the onset of the disorder by addressing its cause appears to be the most logical solution in the light of a missing cure. Doctors screen high risk patients for early signs of pulmonary hypertension such as those whose family history involves an encounter with pulmonary artery high blood pressure. This would also include patients with connective tissue diseases more so limited systemic sclerosis and congenital heart disease.

Patients with symptoms of external dyspnea (shortness of breath), angina (chest pain or discomfort) or syncope (loss of consciousness) would also be screened for pulmonary hypertension if other causes of the presenting signs and symptoms can not be identified. In treating pulmonary artery hypertension, doctors also seek to address any associated or causal disease mentioned earlier such as those of the left side of the heart which can increase pulmonary venous pressure.

Dietary interventions involving a hypertension diet and deliberate sodium and fluid reduction would also be necessary including use of high blood pressure treatment drugs such as loop diuretics and potassium-sparing agents. Potassium is important to high blood pressure control. Potassium-sparing agents prevent the loss of potassium via urine excretion. Like other high blood pressure treatment drugs, these agents may also cause potassium levels to be retained in the body to harmful levels as a side effect.

Daily supplemental oxygen may also be necessary to ensure maximal daily duration of normoxia which is a medical term for normal blood oxygen state. Such as any other patient, patients with pulmonary arterial hypertension are encouraged to stay fit by performing normal daily activities. However attempting more forceful exercise may be detrimental and harmful to overall health especially when it results in difficulties breathing.

As part of treatment therapy, pulmonary infections need to be guarded against with abundant determination. Antibiotic treatment excluding vasoconstrictive medications such as decongestants for upper respiratory infections may also be used. Pulmonary artery high blood pressure treatment may also be vascular-targeted aimed at reversing or significantly reducing vasoconstriction which is the narrowing of the blood vessels due to contraction of the muscular wall of the vessels.

Surgical intervention can also be considered as a last resort should drugs fail to bring the disorder under control and effective management. This would include lung transplant. Lung transplant may often not happen fast enough due to the often long list of awaiting patients of different priorities. Four classes of medication for hypertension treatment used by doctors often in conjunction with suggestions offered in hypertension guidelines are as follows;

  • Calcium Channel Blockers (CCBs)
  • Prostacyclin Analogues
  • Endothelin Receptor Antagonists
  • Phosphodiesterase-5 Inhibitors

Hypertension treatment in the form of drugs can be very effective yet each of the drugs has its own set of known blood pressure medication side effects. It is in this context that both doctors and patients of pulmonary arterial hypertension approach drug treatment with care.

Pulmonary artery hypertension in pregnancy is a cause for concern. Pregnancy has been shown to pose an extremely high risk for the woman with pulmonary arterial high blood pressure and her fetus. Women with the disorder are encouraged to permanently avoid pregnancy via sterilization or dual-contraceptive methods. Certain conditions such as pro-thrombosis (formation of blood clots) in women with pulmonary artery high blood pressure have been reported to be provoked by the use of oral contraceptives.

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