Pulmonary hypertension (PH) is a pathological and physiological state characterized by the continuous elevation of the pulmonary artery. It is difficult to diagnose and treat in the early stage, and has a poor prognosis. In the later stage, it will lead to death from right heart failure, which is called “cancer of cardiovascular diseases”.
Introduction to Pulmonary hypertension
Pulmonary hypertension (PAH) is a disease of elevated pulmonary artery blood pressure caused by a variety of reasons. It refers to the average pulmonary artery pressure >25mmHg at rest or >30mmHg during exercise. Right heart catheters are the gold standard of examination.
Five clinical categories
Arterial pulmonary hypertension (PAH)
PH from left heart disease
PH due to pulmonary disease and/or hypoxia
Chronic thromboembolic PH and other pulmonary obstructive diseases
Unknown and/or multifactorial PH
Symptoms and manifestations of pulmonary hypertension
Pulmonary hypertension is usually inconspicuous and difficult to identify in the early stages, presenting as exertional dyspnea and fatigue. Symptoms then worsen gradually, so that the patient may eventually develop severe pulmonary hypertension with signs and symptoms of marked right ventricular failure, exertic chest pain or syncope, and congestion, including peripheral edema, ascite, and pleural effusion. Early detection and early treatment must be achieved to avoid aggravation of the disease.
How is PULMONARY hypertension assessed
Clinical evaluation: WHO functional classification (GRADE ⅰ, ⅱ, ⅲ, ⅳ)
6 minute Walk Test (6MWT)
Biochemical markers: N-terminal B-type diuretic pronaturetic peptide (NT-probNP)
Hemodynamic indexes: Right atrial pressure (RAP), cardiac index (Cl), mixed venous oxygen saturation (SvO2)
Treatment of pulmonary hypertension
Oxygen therapy oxygen therapy can improve the relief of pulmonary artery spasm caused by hypoxia, also has a relaxing effect on bronchi, can improve ventilation.
Right heart failure diuretics and/or cardiac drugs, such as digoxin, dobutamine.
The oral anticoagulant warfarin prevents intra-arteriolar thrombosis.
Targeted drug therapy
Endothelin receptor antagonists counteract the vasoconstriction of endothelin, thereby reducing vascular pressure. Common drugs are boshengtan, anlisheng tan.
Phosphodiesterase-5 inhibitors prolong the vasodilatation of nitric oxide (NO). Common drugs sildenafil, tadalafil, vardenafil.
Prostacyclines can not only dilate blood vessels to reduce pulmonary arterial pressure, but also reverse pulmonary vascular remodeling. The commonly used drugs are eprostol, iloprost, berprost and so on.
Guanylate cyclase agonist can increase the sensitivity of guanylate cyclase to endogenous NO and directly stimulate the receptor to mimic the effect of NO. The commonly used drug is prooxiegak.
The surgical treatment
Lung transplantation or cardiopulmonary transplantation is recommended for patients with advanced resistance pulmonary hypertension or for patients who have failed to respond to targeted drug therapy.
Daily life management in patients with pulmonary hypertension
High nutrition, less salt and oil, light diet
Maintain a regular routine, quit smoking and drinking
Avoid depression and anxiety and stay relaxed
Adhere to the ladder walking, moderate exercise
Women of childbearing age should strictly avoid pregnancy
In conclusion, pulmonary hypertension is a disease with complex pathogenesis and poor prognosis. Early diagnosis and reasonable treatment play a vital role in improving quality of life and long-term prognosis. General treatment and the application of targeted drugs can effectively control and relieve PULMONARY hypertension and significantly improve the survival rate of patients.