2024/07/01
Cardiology-劉崢偉
Fatigue, fainting, chest pain...
Beware of pulmonary hypertension
Unveiling the Mystery of Pulmonary Hypertension: Exploring Its Causes, Symptoms, and Treatment Options, Along with Introducing the Professional Medical Team and Physicians to Provide Readers with a Comprehensive Understanding and Confidence. In today’s medical field, treatment guidelines for pulmonary hypertension are a critical topic. Although this disease is not as widely recognized as other common conditions, it is a highly challenging cardiac disease, sometimes even humorously referred to as the "cancer of the heart." This article will delve into pulmonary hypertension from various perspectives, including its causes, symptoms, examination and diagnosis, and treatment options, while introducing the professional medical team and physicians to provide patients with accurate treatment guidance and reassurance.
What Causes Pulmonary Hypertension?
Pulmonary hypertension is a rare but dangerous heart disease characterized by the thickening of the blood vessel walls in the lungs, leading to increased pressure in the pulmonary arteries. This condition can be caused by various factors, including chronic lung diseases, thrombosis, congenital heart defects, or genetic predisposition. Additionally, certain medications or substance abuse may also contribute to the development of pulmonary hypertension. Overall, pulmonary hypertension is often the result of multiple contributing factors, necessitating tailored treatment plans based on specific circumstances. The WHO classifies pulmonary hypertension into five types, based on its causes and mechanisms.
Pulmonary Hypertensionof these five categories:
Type 1: Idiopathic Pulmonary Arterial Hypertension (IPAH): This is the most common type of pulmonary hypertension, with an unknown cause. In this condition, there is hyperplasia of the endothelial cells in the pulmonary arteries and arterioles, leading to narrowing of the blood vessels, which obstructs blood flow and increases pressure in the pulmonary arteries.
Type 2: Pulmonary Hypertension Due to Left Heart Disease: This type of pulmonary hypertension is caused by left ventricular diseases, such as valvular heart disease or heart failure. Dysfunction of the left ventricle leads to blood backing up into the pulmonary arteries, which increases pressure in the pulmonary arteries.
Type 3: Pulmonary Hypertension Due to Lung Diseases and/or Hypoxia: This type of pulmonary hypertension is caused by lung diseases, such as chronic obstructive pulmonary disease (COPD) or sleep apnea. These conditions can lead to narrowing of the pulmonary arteries and increased pressure.
Type 4: Chronic Thromboembolic Pulmonary Hypertension (CTEPH): This type of pulmonary hypertension is caused by blood clots blocking the pulmonary arteries or their branches. These clots may result from recurrent pulmonary embolism or chronic thromboembolism.
Type 5: Other Pulmonary Hypertension: This category includes some rare causes of pulmonary hypertension, such as hereditary conditions, metabolic diseases, pulmonary vascular lesions, or external factors like medications or exposure to harmful substances.
These different types of pulmonary hypertension have various causes and pathophysiological mechanisms, thus requiring targeted strategies for diagnosis and treatment.
Common Symptoms of Pulmonary Hypertension?
The symptoms of pulmonary hypertension may vary from person to person and may not be obvious in the early stages of the disease. However, as the condition progresses, here are some common symptoms of pulmonary hypertension:
1.Dyspnea:This is one of the most common symptoms, where patients may experience shortness of breath during daily activities and may even feel breathless at rest.
2.Chest Pain:Sometimes, patients with pulmonary hypertension may experience chest pain or discomfort, which can worsen during physical activities.
3.Fatigue:Patients may experience prolonged fatigue and weakness, which may not improve even after resting.
4.Palpitations:Palpitations refer to the sensation of a rapid or irregular heartbeat, which may occur as the heart beats faster to compensate for the increased pressure in the pulmonary arteries.
5.Dizziness or Fainting:Due to increased cardiac load or insufficient oxygen supply, patients may experience symptoms of dizziness or fainting.
6.Edema:In the advanced stages of pulmonary hypertension, patients may experience edema, particularly in the ankles, legs, or abdomen.
7.Cough:Some patients may experience a persistent cough, which can worsen during physical activities or when lying down.
8.Chest Tightness:At times, patients may feel a sense of tightness or discomfort in the chest, which may be caused by poor blood circulation in the lungs.
9.Angina:In cases of inadequate blood supply to the heart, patients may experience precordial pain, which is due to myocardial ischemia.
The symptoms of pulmonary hypertension may gradually worsen, impacting the patient's quality of life, making early diagnosis and treatment very important. Anyone experiencing the above symptoms should consult a doctor as soon as possible for evaluation and diagnosis.
Tests and Diagnosis for Pulmonary Hypertension?
The symptoms of pulmonary hypertension may gradually worsen, impacting the patient's quality of life, making early diagnosis and treatment very important. Anyone experiencing the above symptoms should consult a doctor as soon as possible for evaluation and diagnosis.
"Blood Tests"
Blood tests can detect specific markers, such as heart failure indices or autoimmune antibodies associated with systemic diseases like viral hepatitis, which are important for diagnosing and monitoring heart conditions. The primary purpose of blood tests is to identify or rule out potential causes of pulmonary hypertension. These testing methods are typically used for a comprehensive assessment of pulmonary hypertension and can help doctors determine the most suitable treatment plan. For patients with pulmonary hypertension, early detection and diagnosis are crucial, as timely treatment can help control symptoms, improve quality of life, and reduce the risk of complications.
"Pulmonary Function Tests,PFTs"
Pulmonary function tests can assess lung function, including lung capacity and airflow rates. While pulmonary function tests cannot directly diagnose pulmonary hypertension, they can help rule out the effects of other lung diseases on the respiratory system and play an important role in comprehensive evaluation. If pulmonary hypertension is caused by lung disease, the treatment will still focus on addressing the underlying lung condition.
"Echocardiography"
Echocardiography is a very safe and non-invasive examination that is highly useful for diagnosing pulmonary hypertension. It allows for the observation of the size and function of the heart's structure during contraction and relaxation, as well as any issues with heart valve insufficiency. In diagnosing pulmonary hypertension, this test can evaluate and estimate right ventricular function and pulmonary artery pressure by measuring the pressure gradient caused by tricuspid regurgitation. When the pressure gradient from tricuspid regurgitation exceeds 40 mm Hg, further evaluation is needed to identify the underlying causes of pulmonary hypertension.
"Computed tomography(CT)"
Computed tomography (CT) plays an important role in diagnosing pulmonary arterial hypertension (PAH). While a CT scan cannot directly confirm PAH, it can provide crucial information for evaluating lung structure and vascular conditions. This information can help doctors rule out other diseases that may cause similar symptoms and serve as part of the diagnostic process for PAH.
computed tomography (CT)
scans in evaluating pulmonary arterial hypertension (PAH):
1.Ruling Out Other Lung Diseases: A chest CT scan can detect direct causes of pulmonary hypertension, such as pulmonary embolism and other lung diseases, which may also lead to similar symptoms.
2.Assessing Lung Structure and Pulmonary Vessels: A CT scan can provide high-resolution images of lung structure and assess the condition of the pulmonary vessels, including the size of the pulmonary arteries, branching patterns, and whether increased pulmonary artery pressure has led to dilation of the pulmonary arteries.
3.Observing Changes in Lung Tissue: A chest CT scan can detect changes in lung tissue, such as parenchymal changes and interstitial fibrosis, which may be associated with pulmonary arterial hypertension (PAH).
"Nuclear Medicine Myocardial Perfusion Imaging,NM-MPI"
It is a commonly used cardiac examination method for assessing blood flow to the myocardium and overall heart function. This test is frequently employed in cases of coronary artery disease and for evaluating left ventricular systolic function. It helps determine whether pulmonary arterial hypertension is indirectly caused by left heart failure.
In nuclear medicine myocardial perfusion scanning, radioactive isotopes labeled with myocardial perfusion agents are typically injected into the patient's bloodstream and transported to the heart through blood flow. Continuous cardiac imaging is performed under both resting and stress conditions to observe myocardial perfusion. Unlike traditional contrast agents, radioactive isotopes are non-nephrotoxic and are considered a relatively safe examination. Scans can assess blood flow to the heart at rest. During stress conditions, usually induced by exercise or medication to increase cardiac workload, the blood flow to the myocardium under pressure is observed. By comparing images taken at rest and under stress, it is possible to evaluate areas of insufficient perfusion in the heart, as well as the presence of heart diseases such as myocardial infarction or coronary artery stenosis.
has the following advantages:
Non-invasive: Patients do not need to undergo surgery or catheterization procedures, reducing risks and discomfort.
High Accuracy: It can accurately assess blood flow to the heart, with a higher detection rate for conditions such as myocardial infarction and coronary artery disease.
Repeatability: The scan can be performed multiple times as needed to track the progression of heart disease and the effectiveness of treatment.
"lung ventilation perfusion scan"
核子醫學肺通氣灌注掃描(lung ventilation perfusion scan)通過檢測肺部的通氣和血流情況評估是否有失衡的狀況存在,大多用以排除肺衰塞所造成的肺動脈高壓,以及使用抗凝血劑的時機。
"Cardiac Catheterization"
Cardiac catheterization is an invasive procedure that involves inserting a sheath into the femoral vein to guide a pulmonary artery catheter through the venous blood flow directly to the pulmonary artery, allowing for the measurement of pulmonary artery pressure and pulmonary artery wedge pressure. A diagnosis of pulmonary hypertension is confirmed when the average wedge pressure exceeds 20-25 mmHg. During right heart catheterization, the oxygen content between the pulmonary artery and the atrioventricular (AV) junction is also evaluated to determine if congenital heart disease is causing pulmonary hypertension. Typically, when performing cardiac catheterization for pulmonary hypertension, left heart catheterization is also conducted to assess coronary arteries and cardiac function.
Treatment Options for Pulmonary Hypertension?
The treatment options for pulmonary hypertension are diverse and depend on the underlying causes, severity, and individual circumstances of the patient. Generally, the methods for treating pulmonary hypertension include medication, interventional procedures, and surgical options. Among these, medication is the most commonly used approach to improve symptoms such as dyspnea and edema, including diuretics and calcium channel blockers. For patients with primary pulmonary hypertension and pulmonary hypertension caused by autoimmune diseases, if the initial treatment is ineffective, vasodilators such as Sildenafil can be used without prior assessment. The treatment for pulmonary arterial hypertension (PAH) has several characteristics, and the following are some of the main features:
Mechanism of Action: Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor that increases vasodilation by inhibiting the activity of the PDE5 enzyme, particularly in the blood vessels of the pulmonary artery. This reduces pulmonary artery resistance and improves blood flow in the pulmonary artery.
Dilation of the Pulmonary Artery: One of the main features of pulmonary hypertension is the contraction and narrowing of the pulmonary blood vessels. Sildenafil's effects can dilate these blood vessels, thereby reducing vascular resistance in the pulmonary artery, alleviating the heart's workload, and improving exercise tolerance.
Symptom Relief: Sildenafil can improve patients' exercise tolerance and quality of life by alleviating symptoms of pulmonary hypertension, such as shortness of breath, chest pain, and fatigue.
Delay Disease Progression: Appropriate use of Sildenafil can delay the progression of pulmonary hypertension and may reduce patients' hospitalization rates and mortality.
If symptoms of heart failure and shortness of breath remain uncontrolled after treatment with Sildenafil and pulmonary artery pressure remains high, a request can be made for second-line treatment medications. However, these medications must be applied for prior authorization through health insurance, and can only be used after approval is granted.
Which clinic should I visit for pulmonary hypertension?
PAH There may be some challenges, primarily including the following aspects:
Lack of obvious physical symptoms: In the early stages, patients may lack noticeable signs, and procedures like cardiac auscultation or chest X-rays often do not provide clear diagnostic information.
Need to Exclude Other Diseases: The diagnosis of pulmonary arterial hypertension (PAH) requires ruling out other conditions that may cause similar symptoms, such as pulmonary embolism, lung diseases, and heart valve disorders.
Lack of Standardization in Diagnostic Criteria: Currently, there is no uniformity in the diagnostic criteria for confirming pulmonary arterial hypertension (PAH). Different medical institutions or expert organizations may have variations, leading to subjectivity and uncertainty in the diagnosis.
Need for Professional Examination and Assessment: Diagnosing pulmonary arterial hypertension (PAH) requires a series of professional examinations and assessments, including echocardiography, cardiac magnetic resonance imaging, and pulmonary ventilation-perfusion scans.
The diagnosis and treatment of pulmonary arterial hypertension (PAH) require collaboration among various specialized medical teams, including cardiology, pulmonology, and rheumatology/immunology. These specialists possess different areas of expertise and skills, allowing them to work together in the diagnostic and treatment process to ensure that patients receive comprehensive assessment and care.
Cardiologists: Cardiologists are typically responsible for assessing heart function, including echocardiography, electrocardiograms, and cardiac magnetic resonance imaging, to rule out the effects of heart diseases on pulmonary artery pressure and to establish the diagnosis of pulmonary arterial hypertension.
Pulmonologists: Pulmonologists are typically responsible for evaluating and treating respiratory system-related diseases, including the diagnosis of lung diseases and pulmonary arterial hypertension. They may conduct pulmonary function tests, chest CT scans, and other examinations to rule out other lung conditions.
Rheumatologists/Immunologists: Rheumatologists or immunologists typically focus on autoimmune diseases, as certain autoimmune conditions, such as systemic sclerosis, may be associated with pulmonary arterial hypertension. They may perform relevant blood tests and assessments to determine the presence of related autoimmune diseases.
Comprehensive Assessment: These specialized physicians need to make a comprehensive assessment based on the patient's medical history, clinical presentations, and examination results to establish a diagnosis and develop a treatment plan. They may need to hold regular meetings to discuss the patient's condition to ensure ongoing monitoring and adjustments to treatment.
In summary, interdisciplinary teamwork is crucial for the diagnosis and treatment of pulmonary arterial hypertension, as it helps ensure that patients receive comprehensive evaluation and care while providing appropriate treatment options.

2024/10/30 18:11:47