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Pulmonary hypertension is an increase in arterial blood pressure in the pulmonary or lung vasculature.

Causes

Pulmonary hypertension can be primary or secondary. Primary indicates that it is occurring without an obvious cause and secondary can be as a result of many disease processes such as asthma or lung fibrosis.

Signs, symptoms and examination findings

Normal pulmonary arterial pressure in a person living at sea level has a mean value of 12-16mmHg. Definite pulmonary hypertension is present when mean pressures exceed 30-20mmHg. A history usually reveals gradual onset of shortness of breath, fatigue, angina pectoris, syncope (fainting) and peripheral edema.

A common association with chronic pulmonary hypertension is cor pulmonale (right sided heart failure) believed to be caused by the increased load on the right ventricle and atrium of the heart. A chest radiograph (x-ray) will often reveal an enlarged right atrium and ventricle, and prominent pulmonary arteries. An ECG will often demonstrate right ventricular hypertrophy.

Risk factors

Women are almost twice as likely to present with primary pulmonary hypertension (PPH) than men. Obesity is among the risk factors.

Treatment

Treatment is determined by the condition underlying the cause of the hypertension. For instance, long term oxygen therapy can be useful in patients with obstructive lung disease. In PPH, lifestyle changes, digoxin, diuretic, oral anticoagulants, oxygen therapy and vasodilators are the mainstays of treatment.

Prognosis

Several studies have reported a mean survival of 2-3 years from time of diagnosis with the cause of death usually being right ventricular failure

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