Many are familiar with hypertension or high blood pressure, a common condition that occurs when the force of your blood pushing against the walls of your blood vessels is consistently high. But there is another type of hypertension that’s less often talked about: pulmonary hypertension (PH) or high blood pressure in the lungs. It’s also referred to as pulmonary arterial hypertension (PAH).
What is PH?
Our lungs are threaded with large and small blood vessels. These vessels bring blood from the right side of your heart to pick up fresh supplies of oxygen that are in turn delivered to the left side of your heart and then to the rest of the body.
Over time, the blood vessels of the lungs can become damaged and narrowed, leading to high blood pressure in the lungs knows as pulmonary hypertension.
Normally when we have our blood pressure taken it is measured by a cuff on your arm; but your regular blood pressure is not directly related to the pressure in your lungs. With PH, the pressure in the lungs increases, while the blood vessels that supply the lungs constrict and narrow. This narrowing can also lead to the artery walls thickening, which makes it harder for the right side of the heart to get the blood flow through the lungs and then to the left side of the heart and to the rest of the body.
This leads to the vessels being unable to carry as much blood and oxygen to the rest of the body, sort of like when a garden hose becomes kinked, and the pressure backs up. When this happens, the heart has to work even harder as it tries to force the blood through. If the pressure is high enough, eventually the heart won’t be able to keep up, resulting in less blood being able to circulate through the lungs to pick up oxygen. It’s at this point that PH symptoms begin to show.
Symptoms of PH
It may take months or years before the constrictions and narrowing in the arteries become severe enough for noticeable symptoms to occur. Often, the symptoms of PH are not immediately identifiable with PH, since many of the symptoms are common to other conditions.
Each person with PH will experience a different assortment of symptoms with the severity differing from person to person. Here are some of the most common ones:
- Breathlessness or shortness of breath
- Chest pain also known as angina pectoris
- Dizziness and fatigue
- Fainting
- Loss of energy
- Swelling of the arms, legs, ankles, or abdomen
- Dry cough
- Low oxygen levels can lead to a bluish color to the skin and lips called cyanosis
Risk factors
PH can be diagnosed in people of all races, ages and ethnic backgrounds, but there are certain risk factors that can predispose some people more likely to get the disease. Having a family history of PH, being obese or suffering from sleep apnea will put you at a higher risk. Women are two and a half times more likely to develop idiopathic PH, and are at a greater risk at childbearing age or when they are pregnant. Congenital heart disease, lung disease, liver disease and lupus can also make a person more predisposed, as does the use of methamphetamines or having taken the diet drug “fen phen.”
Diagnosis
Diagnosing PH is not always easy. Many of the symptoms associated with PH are also common in other conditions, making it difficult to decipher the cause. If your physician suspects PH, they will probably conduct some of the following tests:
- Blood tests
- Chest x-rays
- Electrocardiogram (ECG)
- Echocardiogram
- Pulmonary function tests
- Exercise Tolerance Test or a six-minute walk test
- Nuclear Scan
After conducting initial testing for PH, and if the results are indicative of this condition, a physician will most likely call for a right-heart catheterization, which is one of the most accurate and useful tests for diagnosing PH. Another test that is often used once a patient does get a definitive diagnosis of PH is a vasodilator study. This test can help determine if a patient is suitable for calcium channel blockers and his or her long-term prognosis.
Treatment for PH
A diagnosis of PH can be very overwhelming and might leave a patient with many questions. Though there is no cure for PH, there are many treatment options available that help deal with the condition. Treatments include conventional medical therapies and oral, inhaled, intravenous and subcutaneous options. A possible heart or lung transplant might also be necessary, depending on the severity of the PH.
No two patients with PH will be treated the same, since each case is different. Your doctor and healthcare team will help you decide on the best treatment options for you.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical contributor for the Fox News Channel’s Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com, davidsamadiwiki, davidsamadibio and Facebook
