PULMONARY HYPERTENSION

PULMONARY HYPERTENSION

out line:INTRODUCTION

BRIEF HISTORY

WHAT IS PH?

WHAT CAUSES PH?

SIGNS AND SYMPTOMS

DIAGNOSIS OF PH

TREATMENT OF PH

out line:INTRODUCTION

BRIEF HISTORY

WHAT IS PH?

WHAT CAUSES PH?

SIGNS AND SYMPTOMS

DIAGNOSIS OF PH

TREATMENT OF PH

In the human body, there are two types of

circulation that enable distribution of

blood throughout the body.

The portion that pumps oxygenated blood

from the left side of the heart via the left

ventricle to all parts of the body is known

as the systemic circulation

Introduction

Introduction

On the other hand, the portion that

pumps deoxygenated blood from the

right side of the heart via the right

ventricle into the lungs to obtain

oxygen is referred to as the

PULMONARY CIRCULATION.

Millions of people are affected by a

condition known as high blood

pressure (hypertension) whereby the

blood travels through the body’s

arteries at a pressure higher than

normal.

INTRODUCTION

Pulmonary hypertension is a less common type of

high blood pressure that affects the arteries in

the lungs.

Pressures in the lung arteries are normally

lower than the pressures in the systemic

circulation.

Pulmonary hypertension occurs when the

pressure in the pulmonary circulation becomes

abnormally elevated.

This disease can occur in men, women and

children of all ages. However, it is most

common in females between 20 and 40 years

old.

The condition is rare in children but is

sometimes seen in infants born with heart

defects. Pulmonary hypertension may be a

primary or secondary cause of hypoxia in

neonates.

Ordinarily, blood vessels in the lungs provide less resistance to blood flow than blood vessels in the rest of the body . And blood pressure is usually much lower in the lungs. While pressure in general circulation is about 120/80 mm Hg, in the pulmonary arteries, it is only around 25/15 mm Hg.

Mean (average) pulmonary artery pressure

= number between highest and lowest pressures

Normal

at rest : 14 mm Hg

Pulmonary hypertension

at rest : 25 mm Hg during exercise : 30 mm Hg

Types of pulmonary hypertension

Primary Pulmonary Hypertension

no underlying cause for the high blood pressure

in lungs

Begin with spasm of the muscle layer in

pulmonary arteries

patients are sensitive to substances that cause

blood vessels to constrict

may have an inherited predisposition for the

disease

causes of Secondary Pulmonary

Hypertension

• results directly from another medical

problem

•Chronic Obstructive Pulmonary Disease,

scleroderma, pulmonary fibrosis, lung

diseases such as asbestosis in this

diseases flow of blood impedes through the

lungs.

WHAT CAUSES PULMONARY

HYPERTENSION?

Causes of secondary PH blood clots in the lungs (pulmonary emboli)

chronic obstructive pulmonary disease such as emphysema

Connective tissue disorders, such as scleroderma

Upper airway obstructed during sleep

obesity with reduced ability to breathe

lung diseases such as pulmonary fibrosis (causes scarring in the tissue between the lungs’ air sacs)

Left-sided heart failure

• heart’s left ventricle weakens and cannot pump out enough blood

• increase in pressure backs up blood through pulmonary veins to arteries in lungs

Conginital heart disease

Pathophysiology of pulmonary hypertension

Abnormally high BP in pulmonary arteries

Increased pressure damages large and small pulmonary arteries

Thickness of Blood vessel walls

Cannot transfer oxygen and carbon dioxide normally

Levels of oxygen in blood fall

Constriction of pulmonary arteries

increase in pressure in pulmonary circulation

Pulmonary Hypertension

right side of heart must work harder push blood through pulmonary arteries to lungs

right ventricle thickens and enlarges

cor pulmonale

Heart Failure

In some people, the bone marrow will produce more red blood cells to compensate for less of oxygen in blood.

Extra RBCs cause the blood to become thicker and stickier, further increasing the load on the heart Pulmonary Embolism

Functional Classification

A. Class I- Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnoea or fatigue, chest pain, or near syncope.

B. Class II- patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnoea or fatigue, chest pain, or near syncope.

C. Class III- patients with pulmonary hypertension resulting in marked. Limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes undue dyspnoea, fatigue, and chest pain or near syncope.

D. Class IV -patients with pulmonary hypertension with inability to carry out any physical activity without symptoms. these patients manifest signs of right heart failure. Dyspnoea and /or fatigue may be present even at rest. Discomfort is increased by any physical activity

SIGNS AND SYMPTOMS

Signs and symptoms shortness of breath fatigue or light-headed upon exertion

dizziness or fainting spells (syncope)

swelling (edema) in ankles, legs and eventually in abdomen (ascites) – fluid leak out of veins and into tissues

bluish colour to lips and skin (cyanosis)

coughing (sometimes with blood) and wheezing

distended neck veins

enlarged liver

heart palpitations

Chest pain

feel weak – body tissues not receiving enough oxygen

DIAGNOSIS OF PH

history of present illnesses

past medical history

Family history

Any past or present medications that the patient may have taken

physical examination will also take place.

Chest X-Ray

Echocardiography (Ultrasonic Cardiography)

Electrocardiogram (ECG)

ECG is a record of the electrical activity produced by the heart. Abnormal rhythms (arrhythmias) may indicate that the heart or part of the heart is undergoing unusual stress.

Pulmonary Angiogram

Used to measure circulation in the lungs and to visualize

clots in the lung on x-rays. The test involves insertion of

a thin catheter into the pulmonary artery through which

an iodine dye is injected.

Image of any blood clots present in the lung can be

observed and circulation of blood through lung’s blood

vessels can be tracked.

Pulmonary Function Tests

Non-invasive tests to measure how much air

your lungs can hold and the airflow in and out of

your lungs. They can also measure the amount

of gases exchanged across the membrane

between the lung wall and capillary membrane.

During the tests, the patient will be asked to

blow into a spirometer. An abnormality here may

be amongst the first indication of PH.

TREATMENT OF PH

fluid restriction diuretics to decrease fluid accumulation cardiac glycosides (eg, digitalis) in an attempt

to improve cardiac function calcium channel blockers for vasodilation, and rest. Intravenous prostacyclin helps to decrease

pulmonary hypertension by reducing

pulmonary vascular resistance and pressures

and increasing cardiac output

Anticoagulants such as warfarin have

been given to patients because of chronic

pulmonary emboli. Heart— lung transplantation has been

successful in select patients with primary

hypertension who have not been responsive

to other therapies

Lung and heart for transplant

Nursing Management

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