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Pulmonary hypertension: Difference between revisions
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<section begin="radiology" />'''Pulmonary hypertension''' (PH) is defined as elevated blood pressure beyond 20 mmHg MAP in the pulmonary artery (physiological MAP is 10-20). It most commonly occurs as a consequence of heart disease or lung disease. '''Pulmonary arterial hypertension''' (PAH) is one form of pulmonary hypertension which is not | <section begin="radiology" />'''Pulmonary hypertension''' (PH) is defined as elevated blood pressure beyond 20 mmHg MAP in the pulmonary artery (physiological MAP is 10-20). It most commonly occurs as a consequence of heart disease or lung disease. '''Pulmonary arterial hypertension''' (PAH) is one form of pulmonary hypertension which is not secondary to heart or lung disease. | ||
Pulmonary hypertension is relatively common, the prevalence being approximately 1%, mostly due to the high prevalence of COPD and heart disease. PH itself can lead to right-sided [[heart failure]]. | Pulmonary hypertension is relatively common, the prevalence being approximately 1%, mostly due to the high prevalence of COPD and heart disease. PH itself can lead to right-sided [[heart failure]]. | ||
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!Frequency | !Frequency | ||
!Common causes | !Common causes | ||
!Pathomechanism | |||
|- | |- | ||
|Group 1 | |Group 1 | ||
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[[Persistent pulmonary hypertension of the newborn]] | [[Persistent pulmonary hypertension of the newborn]] | ||
[[Eisenmenger syndrome]] | |||
|Elevated pulmonary vascular resistance | |||
|- | |- | ||
|Group 2 | |Group 2 | ||
|Pulmonary hypertension secondary to left-sided heart disease | |Pulmonary hypertension secondary to left-sided heart disease | ||
|Very common | |Very common (70% of PH) | ||
|[[Heart failure]] | |[[Heart failure]] | ||
[[Valvular disease]] | [[Valvular disease]] | ||
| | |||
|- | |- | ||
|Group 3 | |Group 3 | ||
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|[[COPD]] | |[[COPD]] | ||
[[Interstitial lung disease]] | [[Interstitial lung disease]] | ||
|Chronic hypoxia causes pulmonary vasoconstriction and remodelling of the pulmonary vascular bed | |||
|- | |- | ||
|Group 4 | |Group 4 | ||
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|Rare | |Rare | ||
|Chronic [[pulmonary embolism]] | |Chronic [[pulmonary embolism]] | ||
|Pulmonary embolism increase pulmonary vascular resistance | |||
|- | |- | ||
|Group 5 | |Group 5 | ||
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|[[Chronic kidney disease]] | |[[Chronic kidney disease]] | ||
[[Sarcoidosis]] | [[Sarcoidosis]] | ||
Haematological disorder | Haematological disorder | ||
| | |||
|} | |} | ||
<section end="radiology" /> | <section end="radiology" /> | ||
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Neither chest radiography or CT are required in the evaluation, except for evaluation of underlying disorders. On x-ray, the central vessels may be more prominent than normal. On CT, one can see that the pulmonary artery is larger than the ascending aorta, and that there is a so-called centroperipheral caliber discrepancy or “pruning” of the peripheral vessels, which means that the central pulmonary vessels are larger than normal while the peripheral vessels aren't. | Neither chest radiography or CT are required in the evaluation, except for evaluation of underlying disorders. On x-ray, the central vessels may be more prominent than normal. On CT, one can see that the pulmonary artery is larger than the ascending aorta, and that there is a so-called centroperipheral caliber discrepancy or “pruning” of the peripheral vessels, which means that the central pulmonary vessels are larger than normal while the peripheral vessels aren't. | ||
[[Echocardiography]] is | [[Echocardiography]] is the main modality for the evaluation, as it can estimate the pulmonary artery pressure. Typical findings include [[tricuspid regurgitation]], [[pulmonary regurgitation]], dilated right atrium and ventricle, and [[right ventricular hypertrophy]]. However, right [[heart catheterisation]] is obligatory for the final diagnosis, as it can directly measure the pressure. | ||
<section end="radiology" /> | <section end="radiology" /> | ||
== Management == | == Management == | ||
Regardless of type and cause, hypoxaemia will worsen the condition and should be avoided. | Regardless of type and cause, hypoxaemia will worsen the condition and should be avoided. | ||
Lung-protective lifestyle changes, including weight loss, smoking cessation, and avoidance of pollutants and microbes, is always indicated. If due to an underlying disease, this should be treated. | Lung-protective lifestyle changes, including weight loss, smoking cessation, and avoidance of pollutants and microbes, is always indicated. If due to an underlying disease, this should be treated. | ||
For pulmonary arterial hypertension, a calcium channel blocker, phosphodiesterase 5-inhibitor, prostanoid, endothelin receptor antagonist, or guanylate cyclate simulator may be used. | For pulmonary arterial hypertension, a calcium channel blocker, phosphodiesterase 5-inhibitor, prostanoid, endothelin receptor antagonist, or guanylate cyclate simulator may be used. For type 4, [[thrombendarterectomy]] with or without balloon dilatation of the pulmonary arteries may cure the condition. For all other types of PH, there is no specific treatment. <noinclude> | ||
<noinclude> | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
</noinclude> | |||