When the pulmonary pressure is more than 25 mm Hg, it is termed as pulmonary hypertension. There is no grading which classifies severe or mind hypertension. Pulmonary hypertension can be due to the arterial or venous cause. Depending upon this one can find out the origin of pulmonary hypertension.
Pulmonary artery hypertension can be due to idiopathic reasons or it can be associated with other causes which include portal hypertension, congenital systemic to pulmonary shunts and at times that there exist the relation between HIV and pulmonary hypertension.
This was about pulmonary arterial hypertension causes. So what can precipitate severe pulmonary venous hypertension? The main cause is left ventricular failure which is considered an important cause for the development of pulmonary venous hypertension. When there is fluid overload in left ventricle it imparts back pressure to the left atrium and similarly left atrium pressure is imparted to pulmonary veins. In severe cases, there is an increase in permeability of veins, which leads to pulmonary edema and symptoms like dyspnea. In severe cases, a person can have dyspnea at rest which is considered to be the most severe form of dyspnea.
Pulmonary hypertension can even occur in combination with interstitial lung diseases. In such cases, due to lack of compliance of lungs, there is an increase in lung pressure. Mostly chronic obstructive lung diseases are found to be the main cause of pulmonary edema.
Pulmonary hypertension can occur physiologically in person traveling to high altitude but that would be just transient and gets resolved as soon as a person comes back to plains.
What Is Severe Pulmonary Hypertension?
A severe form of pulmonary hypertension occurs when it is in association with the chronic thromboembolic state. Elevation of pulmonary artery pressure when there is pulmonary artery obstruction for more than 3 months. And this should be documented then only it would be considered relevant. Non-thrombotic pulmonary embolism may occur in fracture of the femur when a fat embolus gets dislodge from the femur and settle in pulmonary artery causing obstruction.
Pulmonary hypertension can at times precipitate suddenly and can cause severe dyspnea. So a patient coming with a complain dyspnea or any other cardiac complain, a doctor should rule out pulmonary hypertension as it raises the mortality in a patient who already have cardiac disease so timely detection is the key to correct the disease.
Pulmonary hypertension can range from mild to moderate severity, so accordingly one should plan the treatment. The treatment of choice is calcium channel blocker as it causes vasodilation and reduces the resistance of the pulmonary system. The dose of 240 mg is considered ideal for decreasing the pressure in the pulmonary system. Bosentan can also be used as a second line drug to get relief from pulmonary hypertension. It was believed that phosphodiesterase inhibitor like sildenafil can also be used as it causes vasodilation and hence reduces the resistance but sildenafil along with calcium channel blocker should never be used because at times it may cause severe hypotension due to combined vasodilator effect. So before giving a drug doctor should rule out through drug history that what drugs patients are taking. Prostacyclin analogues can also be used which includes iloprost, but there is not much satisfactory outcome after using this drug. Thus use is controversial.
Apart from giving drugs underlying causes should be treated which include correction of cardiac abnormalities or congenital heart diseases. So proper management of underlying cause should be done then the only further progression of the disease can be prevented. And in case of thromboembolic state fibrinolytic should be used but prior to that bleeding time should be documented so as to prevent further complications.
Pulmonary hypertension is a medical emergency. At the time it presents with severe dyspnea. Hence timely management should be done. There is nothing mild or severe. If it occurs it can cause death at times.
