Can Pneumonia Lead To Pulmonary Hypertension?
Can Pneumonia Lead To Pulmonary Hypertension?
Pulmonary hypertension (PH) is defined as the presence of a PAPm (mean pulmonary pressure) greater than 25 mm Hg measured by cardiac catheterization.
Pulmonary hypertension is seen relatively frequently in intensive care units. Despite this, its transcendence has only recently been recognized.
It Manifests Itself In Two Forms: as the aggravation of a pre-existing condition or as a de novo process that complicates an acute condition (pneumonia, heart failure, among others).
In this last situation the diagnosis is not easy, since the values of pressure that are detected are not very high, because the right ventricle is a chamber of volume, with thin walls and has no possibility of generating values greater than 50 mm Hg systolic pressure or 40 mm Hg mean pressure. Subjects with higher values have some previous disease that has conditioned right ventricle so that it can sustain higher pressures.
The Pathogenesis Of Acute Pulmonary Hypertension Is Essentially Based On:
- Increased pulmonary vascular resistance (PVR).
- Increase in pulmonary blood flow.
- A combination of the two preceding mechanisms.
- Increase in pulmonary venous pressure.
- Genetic factors that cause some patients to have an exacerbated response of their pulmonary vasculature to certain stimuli.
PVR Depends On Several Factors: Extrinsic compression produced by intraalveolar pressure and intrapulmonary pressure, remodeling early involvement of the vascular wall, favored by the appearance of smooth muscle in the wall of the small distal arteries of the pulmonary vascular tree, the formation of microthrombi in the light and the activity of mediators such as nitric oxide (NO) and prostacyclines of vasodilator action, endothelin-1, thromboxane and serotonin, vasoconstrictor effect, in addition to others still under study.
All forms of pulmonary hypertension can present in an acute patient. The differential diagnosis must always be considered; the key to diagnosis is in obtaining a thorough medical history, although finally, in all cases, when pulmonary hypertension compromises the right ventricle (RV) by decompensating the patient, the behavior is going to be the attempt to decrease the pulmonary pressure and preserve the RV.
The importance of pulmonary hypertension usually goes unnoticed or disqualified in a patient who is suffering from another serious illness and who may even be in mechanical ventilation. When RV function deteriorates, the diagnosis is more difficult because lung pressures progressively decrease and what at first sight can be interpreted as an improvement it may actually be the beginning of the circulatory collapse.
On the other hand, pneumonia is an acute respiratory disease, of infectious origin, which compromises the pulmonary parenchyma caused by the invasion of pathogenic microorganisms (viruses, bacteria, fungi and parasites).
Adult community pneumonia has an acute evolution, characterized by compromise of general condition, fever, chills, cough, mucopurulent expectoration and respiratory distress; associated in the physical examination for tachycardia, tachypnea, fever and focal signs in the pulmonary examination. The probability of a patient with respiratory symptoms of having pneumonia depends on the prevalence of disease in the environment where it occurs and the manifestations.
The Diagnosis Of Pneumonia Is Clinical-Radiographic: the clinical history and physical examination suggest the presence of a lung infection, but the diagnosis is confirmed when the presence of infiltrates is demonstrated on the chest radiograph. The clinical and Chest x-ray findings do not allow to predict with certainty the etiologic agent of lung infection; the symptoms, signs clinical features and radiographic findings overlap between the different causative agents (classical and atypical bacteria, respiratory viruses).
The chest radiography allows confirming the clinical diagnosis, establishing its location, extension and severity also makes it possible to differentiate pneumonia of other pathologies, detect possible complications, and may be useful in monitoring high-risk patients.
Pulmonary hypertension has been associated with respiratory diseases, such as idiopathic interstitial pneumonias and chronic obstructive pulmonary disease. Non-specific interstitial pneumonia is a pathological entity of idiopathic interstitial pneumonias, of which there are no data or publications associated with PH.
Although some forms of pneumonia have been related, they are not likely a cause of pulmonary hypertension.
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