Pulmonary hypertension
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Pulmonary hypertension
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Transcript
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Pulmonary hypertension refers to increased blood pressure in the pulmonary circulation, more specifically a mean pulmonary arterial pressure that is greater than 25 mmHg.
The pulmonary circulation starts with the right ventricle.
From there - blood is pumped into the large pulmonary trunk, which splits to form the two pulmonary arteries – one for each lung.
The pulmonary arteries divide into smaller arteries known as pulmonary arterioles and then eventually into pulmonary capillaries which surround the alveoli - which are the millions of tiny air sacs where gas exchange happens.
At that point, oxygen enters the blood and carbon dioxide enters the alveoli.
The pulmonary capillaries drain into small veins that join to form the two pulmonary veins exiting each lung, and these pulmonary veins complete the circuit by delivering oxygen-rich blood into the left atrium.
The blood pressure in the pulmonary circulation is normally much lower than the systemic blood pressure.
The normal pulmonary artery pressure is about 25/10 mmHg with a mean arterial pressure of 15 mmHg.
Pulmonary hypertension most commonly develops as a result of left heart disease.
Here the pulmonary blood vessels are normal and undamaged, but the left side of the heart is unable to pump efficiently – for example because of heart failure or valvular dysfunction.
This causes a backup of blood in the pulmonary veins and capillary beds, which can increase the pressure in the pulmonary artery.
Summary
Pulmonary hypertension (PH) is a condition characterized by an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries. It can be due to left heart disease, chronic lung disease, or other conditions that specifically cause pulmonary arterial hypertension. Regardless of the cause, it can complicate right-sided heart failure, what's referred to as cor pulmonale. Symptoms of PH include shortness of breath, dizziness, fainting, and leg swelling. Treatment focuses on the underlying cause and may include supplemental oxygen, and medications like endothelin receptor antagonists and prostacyclins.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Pathogenesis of Pulmonary Arterial Hypertension" Circulation (2005)
- "ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension" Journal of the American College of Cardiology (2009)
- "Updated Clinical Classification of Pulmonary Hypertension" Journal of the American College of Cardiology (2013)
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