Pulmonary hypertension (PH) is a common type of hypertension of the arteries in the lungs and the heart's right side. The disease involves blocking, narrowing, or destruction of blood vessels in the lungs. PH is an extremely complex disease that is often misunderstood in the medical field. In normal hypertension, the pressure is higher than normal in the blood vessels; however, with PH, blood vessels that are affected are specifically those situated in the lungs. Since the lungs are critical in the oxygenation of blood circulated throughout the body, the arteries' damage limits their function. PH is a serious health concern that requires accurate diagnosis and the right treatment once systems are detected.
Incidence and Prevalence
The incidence and prevalence of the disease are worrying both locally and on a global scale. A survey conducted by Prins and Thenappan (2016) finds that PH ranges from one to two cases per million Americans. Internationally, the study observes a prevalence of 2.5 to 7.1 cases per million people in the general population. On average, adults ranging between 5 and 52 million adults are affected by the disease. The relationship between the condition and other illnesses remains unknown as far as the United States is concerned. However, researchers like Prins and Thenappan (2016) suggest that PH appears in 2 percent of patients with HIV infection or portal hypertension. Recent investigations have also associated the disease with the intake of certain supplements and medications.
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The prevalence of PH is determined by a wide range of factors that serve as the underlying causes or drivers of the degree of prevalence. For instance, the Center for Disease Control and Prevention (CDC) points out that the prevalence depends on the existence of conditions like heart and lung complications (Hoeper et al., 2016). These complications include coronary artery disease, heart defect, liver disease, high blood pressure, blood clots, or connective tissue disease. The prevalence of the disease is not restricted to the conditions above. Other unknown causes contribute to at least 40 percent of PH illnesses (Hoeper et al., 2016). Some researchers argue that its prevalence may be significantly more than what the current figures show because it is a misunderstood disease.
Pathogenesis and Pathophysiology
Most of the time, physicians cannot find reasons for the high blood pressure in the lungs. Current studies such as that of Hoeper and his collaborators (2016) suggest that the interplay of genes and other conditions such as illnesses may contribute to the disease. They include HIV, blood clots, congestive heart failure, drug use, heart defects, lupus, and lung diseases (Hoeper et al., 2016). In another study, Noordegraaf, Westerhof, and Westerhof (2017) find that altered pulmonary vascular endothelium is responsible for developing PH. According to the authors, the heart and lungs work together in carrying oxygen throughout the body. The heart consists of two halves – the right and the left. The right side receives deoxygenated blood from the body, which then pumps into the lungs. Oxygenated blood travels to the left side of the body from the lungs, then pumped to the rest of the body. Thus, when the arteries in the lungs develop problems, the heart is also affected.
Signs and Symptoms
Symptoms of the disease may go unnoticed for a while. Pulmonary Hypertension Association mentions that common symptoms of PH may be caused by other medical issues, including chronic obstructive pulmonary disease (COPD) or asthma ("About Pulmonary Hypertension (PH)," 2020) . That being so, it requires a specialist to identify and perform a physical examination of a patient suspected to have PH. Symptoms of the disease include mild headaches and fainting, chest pains, experiencing fatigue most of the time, shortness of breath, swelling of the feet, and palpitations ("About Pulmonary Hypertension (PH)," 2020) . These symptoms are progressive in that they get worse with time. Some patients may not be able to perform routine tasks without getting winded.
Diagnosis and Treatment
A major problem in performing clinical diagnosis of PH in its early stages is its lack of specific symptoms until the disease advances to its adverse state. A doctor may perform a physical examination to detect signs of irregular heart sounds, swelling in the legs and abdomen, and visible and enlarged veins on the sides of the neck (Nathan et al., 2019). Further tests may be performed, including an echocardiogram to check for blood pressure in the pulmonary arteries. Two, perform a CT scan to check whether pulmonary arteries are swollen. Three, chest X-rays to check if the lung and heart conditions were causing the problem. Treatment is only offered once a doctor ascertains that a patient is suffering from the disease.
Treatment plans differ since PH in people is not the same. Common types of clinical interventions include vasodilators, transplantation, and anticoagulation. Vasodilators are medications designed to open blocked or narrowed blood vessels Noordegraaf, Westerhof, and Westerhof (2017). For a patient with PH, these medications alter muscles on the arteries' walls, thus preventing them from tightening, which causes them to narrow. By doing so, blood flows more freely through the blood vessels. The transplantation procedure involves replacing the heart and lungs with more healthy ones. It is a complicated procedure that is only performed on patients with chronic cases of PH. Anticoagulation is also medication that prevents blood clots in the blood vessels. These medications are prescribed to patients who are at a higher risk of experiencing blood clot induced PH.
Prognosis
As mentioned earlier in the text, lungs function in close collaboration of the heart. Thus, when the lungs' blood vessels are blocked, narrowed, or destroyed, the heart becomes more vulnerable to complications. Nathan et al. (2019) say that PH can cause the failure of the right side of the heart. PH is a progressive disease, which means a patient gets worse with time. When a patient does not get successful treatment of the disease, their heart may fail completely. Heart failure occurs over overtime. At first, the left side of the heart's right side becomes enlarged because it has to pump blood hard than usual. The thickening of the walls to compensate for increased pumping causes a straining effect that the ventricles can no longer hold, thereby failing eventually.
Other complications include blood clots, bleeding in the lungs, arrhythmia, and pregnancy complications Noordegraaf, Westerhof, and Westerhof (2017). Patients with PH are more likely to develop blood clots in the arteries of the lungs because of the blocked vessels. That can also lead to another life-threatening problem of bleeding in the lungs or coughing out blood. Arrhythmia refers to the irregular heartbeats caused by irregular pumping of blood. Arrhythmia can lead to other complications like fainting or palpitations. Lastly, PH can have a life-threatening effect on a pregnant woman and her developing baby because of insufficient oxygen supply.
Conclusion
PH is a serious disease that needs the undivided attention of medical practitioners. As the discussion demonstrates, it is a silent killer with an unknown set of symptoms. It is easier to misunderstand or mistake the disease for another because it shares a number of symptoms with other illnesses. The extent to which the medical problem is prevalent is largely attributed to the fact that it is complicated. A lung and heart are the two most important organs that support the life of human beings. Disruption of their normal functioning can cause irreversible damage to a person's health.
References
About Pulmonary Hypertension (PH) . Pulmonary Hypertension Association. (2020). Retrieved 11 September 2020, from https://phassociation.org/patients/aboutph/.
Hoeper, M. M., Humbert, M., Souza, R., Idrees, M., Kawut, S. M., Sliwa-Hahnle, K., ... & Gibbs, J. S. R. (2016). A global view of pulmonary hypertension. The Lancet Respiratory Medicine , 4 (4), 306-322.
Nathan, S. D., Barbera, J. A., Gaine, S. P., Harari, S., Martinez, F. J., Olschewski, H., ... & Weissmann, N. (2019). Pulmonary hypertension in chronic lung disease and hypoxia. European Respiratory Journal , 53 (1).
Noordegraaf, A. V., Westerhof, B. E., & Westerhof, N. (2017). The relationship between the right ventricle and its load in pulmonary hypertension. Journal of the American College of Cardiology , 69 (2), 236-243.
Prins, K. W., & Thenappan, T. (2016). WHO Group I Pulmonary Hypertension: Epidemiology and Pathophysiology. Cardiology Clinics , 34 (3), 363.
