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 becomes damaged, such as in pulmonary arterial hypertension, the thickening and stiffening of the pulmonary artery walls occur which causes 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) as the place where the obstruction lies.

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

References

1. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S, and European Association of Echocardiography. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010 Mar;11(2):202-19. DOI:10.1093/ejechocard/jeq004 |