What happens in the blood vessels of the lungs
The pulmonary vessels are normally wide and pliable, the pressure in them is much lower than in the systemic circulation. In pulmonary hypertension, the lumen of blood vessels narrows due to spasm, wall thickening, blood clots, or compression by altered lung tissue. The right ventricle, adapted to low resistance, is forced to sharply increase its work. First, it hypertrophies, then expands, and stagnation develops in a large circle: swelling of the legs, heaviness in the right hypochondrium, enlargement of the abdomen. Oxygen delivery is also impaired, which explains the severe weakness.
- Narrowing and restructuring of the pulmonary vessels
- Increased resistance to blood flow
- Hypertrophy and dilatation of the right ventricle
- Stagnation in the systemic circulation
- Decreased blood oxygen saturation
Main groups of reasons
Most often, pulmonary hypertension is secondary. The most common cause is diseases of the left side of the heart: valve defects and heart failure, in which pressure is transmitted back to the vessels of the lungs. The second most common group is chronic lung diseases: obstructive disease, fibrosis, severe sleep apnea. A separate chronic thromboembolic form is identified after suffering pulmonary embolism - it is important because in some cases it can be treated surgically. Finally, there is rare pulmonary arterial hypertension, including in systemic connective tissue diseases and congenital heart defects.
- Diseases of the left side of the heart and valve defects
- Chronic obstructive pulmonary disease, fibrosis
- Severe sleep apnea
- Chronic thromboembolic pulmonary hypertension
- Systemic connective tissue diseases
- Congenital heart defects
- Rare idiopathic form
Symptoms
Early manifestations are nonspecific, so it often takes a long time from the first complaints to diagnosis. The main symptom is shortness of breath on exertion, which gradually worsens. Severe fatigue, dizziness, and sometimes fainting during physical effort are added - an alarming sign. Later, swelling of the legs, heaviness and pain in the right hypochondrium due to an enlarged liver, enlargement of the abdomen, and swelling of the veins of the neck appear. Possible palpitations, dry cough and hoarseness when the pulmonary artery dilates.
- Increasing dyspnea on exertion
- Weakness and decreased stamina
- Dizziness, fainting on exertion
- Swelling of the legs, enlargement of the abdomen
- Heaviness in the right hypochondrium
- Blueness of lips and fingers
- Chest pain or discomfort
Diagnostics
The first step in case of unexplained shortness of breath is echocardiography: it allows you to assess the pressure in the pulmonary artery, the condition of the right side of the heart and find diseases of the left side of the heart. At the same time, the lungs are examined: spirometry, X-ray or CT. To exclude the chronic thromboembolic form, special imaging methods of pulmonary vessels are used, since this particular form has a special treatment. Tests for connective tissue diseases and assessment of liver and kidney function are required. The final confirmation and determination of severity is provided by catheterization of the right heart, performed in a specialized hospital.
- EchoCG as the first method
- ECG with signs of overload of the right departments
- Spirometry and assessment of blood oxygen saturation
- CT scan of the pulmonary arteries and lung tissue
- Sleep study for suspected apnea
- Tests for systemic diseases
- Right heart catheterization
Treatment
The tactic depends entirely on the reason. For diseases of the left side of the heart, heart failure and defects are treated, for lung diseases - the underlying disease, oxygen is prescribed for a persistent decrease in saturation, and sleep apnea is treated. In the chronic thromboembolic form, surgical removal of organized blood clots or balloon angioplasty of the pulmonary arteries, as well as continuous anticoagulant therapy, are possible. Specific drugs that dilate the pulmonary vessels are used strictly for certain forms and are prescribed only in specialized centers: in other cases they can be harmful. All patients are advised to undergo vaccination against respiratory infections, stop smoking, dosed activity and caution during pregnancy, which is extremely dangerous in this condition.
- Treatment of underlying heart or lung disease
- Oxygen therapy according to indications
- Anticoagulants for thromboembolic form
- Surgical treatment for chronic thromboembolism
- Specific therapy only as prescribed by a specialist
- Smoking cessation, vaccination, weight control
- Pregnancy planning must be discussed
