By L.J.T. Reaves

Oxygen-depleted blood arrives in the right side of the heart. It is pumped from the top chamber (atrium) to the chamber underneath it (ventricle). The ventricle pumps the blood into the pulmonary arteries, which deliver it to the lungs. The lungs replenish the blood with oxygen before sending it to the left side of the heart for circulation to the body.

Pulmonary hypertension (PH) is characterized by high blood pressure in the pulmonary arteries and right ventricle. The path from the bottom chamber to the lungs is constricted. Less blood is allowed to flow through the pulmonary vessels, which makes the right ventricle work harder than normal. This can cause a number of symptoms as well as several complications that lead to other serious health conditions.

Early Signs Of Pulmonary Hypertension

Signs of pulmonary hypertension are not always evident, especially in mild cases. However, the condition tends to worsen over time. The patient may experience several symptoms as the blood vessels leading from the right side of the heart to the lungs become increasingly narrowed. He or she may feel chest pain or pain in the upper abdomen. Shortness of breath is also common, and particularly so after strenuous physical activity. Some patients feel a sense of fatigue and weakness as their bodies’ tissues become deprived of oxygen.

As PH worsens, swelling may occur in the lower legs. The patient may also experience periods of lightheadedness following exercise, and even lose consciousness when their hearts are severely taxed. Cyanosis (bluish color on the skin) may also develop, reflecting the lack of oxygen in the tissues.

Potential Problems That Occur Without Treatment

If pulmonary hypertension is not treated, the elevated blood pressure in the pulmonary arteries and right ventricle can cause serious health issues. For example, blood clots may develop in the legs as blood continues to pool within the legs’ blood vessels. Once clots form, they can break off and migrate to the heart and lungs.

Reduced blood flow in the lungs, combined with the increased workload placed upon the right side of the heart, can disrupt the heart’s normal rhythm. This can cause arrhythmias. Some arrhythmias are mild, and present few, if any, long-term problems. Others are severe, and can be fatal.

Another complication occurs as the right ventricle continues to meet the increasing demands placed upon it. As already noted, the chamber is forced to pump blood harder against the resistance within the constricted pulmonary vessels. It is able to do so at first by thickening its walls and growing larger. Eventually, however, even this is not enough. The ventricle becomes unable to meet the body’s needs for oxygen-rich blood. This is referred to as congestive heart failure.

Treating Pulmonary Hypertension To Minimize Lung Damage

The goal of treatment for PH is to relieve the patient’s symptoms while reducing the risk of permanent lung damage. This involves identifying and, if possible, correcting any underlying issues that are contributing to the condition (e.g. blood clots, heart valve disease, etc.). Therapy typically begins with one or more medications that are given to reduce the stress placed upon the patient’s heart.

Anticoagulants are usually given if there is a high risk of clotting. Calcium channel blockers may be administered to help dilate the pulmonary arteries, thereby improving blood flow to the lungs. If the doctor suspects fluid buildup in the lungs (known as pulmonary edema), diuretics may be given.

Surgery can be performed in select cases. For example, if heart valve disease is contributing to PH, a surgeon may attempt to repair or replace the affected valve. If a large blood clot in the pulmonary arteries (i.e. a pulmonary embolism) has reduced blood flow to the lungs, emergency surgery can be performed to remove it. In rare cases, namely when other treatment options have failed to improve the patient’s condition, a lung transplant may be performed.

High blood pressure in the arteries of the lungs is dangerous since it can damage the lung tissue, and lead to heart failure. While the condition cannot technically be cured, it can be managed with treatment.

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