Pulmonary Hypertension
Pulmonary hypertension is a rare cause of high blood pressure ( hypertension ) in the pulmonary artery ( pulmonary artery ) . When the blood vessels of the lungs may be damaged , such as in pulmonary arterial hypertension, this allows for thickening and stiffening of the pulmonary artery walls , and this may cause deviations in the vessel wall. The consequence of this is that the pressure in the pulmonary artery rises and also in the RV. PH is a pressure load on the right heart . Click here to see an animation about PH .
WHO classification Pulmonary hypertension is classified by the World Health Organization (WHO ) to the place where the obstruction is .
classification subcategories Pulmonary Arterial Hypertension ( PAH )
• Idiopathic PAH ( unknown cause ) • Familial PAH ( genetic cause) • PAH by underlying causes as , connective tissue diseases , congenital heart disease , portal hypertension , HIV infection , drugs , drugs , toxins , and other factors . • PAH with significant venous and / or capillary involvement • Persistent pulmonary hypertension of newborn
Pulmonary hypertension with left heart disease
• In disorders of left atrium and ventricle of the heart
• With Valvular
Pulmonary hypertension in pulmonary disease and / or hypoxemia
• Chronic obstructive pulmonary disease ( COPD ) • Interstitial lung disease • Sleep disorders , alveolar hypoventilation ; chronic exposure to high altitude
• Congenital malformations / developmental Pulmonary hypertension due to chronic thrombotic and / or embolic processes
• Thromboembolic obstruction of proximal pulmonary arteries • Thromboembolic obstruction of distal pulmonary arteries • embolism of the lung ( eg tumor , parasites , foreign body , bone marrow )
Pulmonary hypertension as a result of other diseases and disorders
• Sarcoidosis • Histiocytosis X • Lymfangioleiomyomatose • Sickle Cells • Compression of the pulmonary vessels from outside ( eg by lymphadenopathy , tumor , fibrosing mediastinitis )
• storage disorders
Evidence of pulmonary hypertension Unlikely Possible Likely SPAP <36 mmHg 36-50 mmHg > 50 mmHg TR Vmax < 2.8 m / s 2.9-3.4 m / s > 3.4 m / s Acct > 120 ms 120-60 ms <60 ms RV MPI ( TCO-ET/ET ) < 0.36 RV MPI ( TDI ) < 0:50 Calculations for estimating pressure in the pulmonary artery formula Systolic PA pressure 4 x ( TR Vmax ) ² + estimated RA pressure Diastolic PA pressure 4 x ( PR Ved ) ² + estimated RA pressure Mean PA pressure 0.3 x systolic PA pressure + 0.6 x diastolic PA pressure 90 - (0.62 x ACCT ) if Acct < 120ms 4 x ( PR Vmax ) ² + estimated RA pressure TR PGmean + estimated RA pressure Example severe pulmonary hypertension
Short acct with "systolic notch" Flattened septum
Increased Systolic PA pressure Increased MPI , extension of isovolumetric times . Source : Eur Respir Rev 2012 ; 21: 125 , 239-248