Pulmonary hypertension is the generalized name for a group of diseases that are characterized by a progressive increase in pulmonary vascular resistance leading to right ventricular failure and, as a consequence, premature death. This disease was first detected in 1891 by Dr. Ernst von Romberg, and in 1973, at a meeting of the WHO, an attempt was first made to classify pulmonary hypertension. First, pulmonary hypertension was divided into primary and secondary. Primary hypertension, in turn, was divided into obliterating, arterial, reticular and thromboembolic forms. Later, in 1998, at the second conference held in Evian-les-Bains, it was proposed to classify pulmonary hypertension on the basis of clinical manifestations. According to the latest classification, there are five types of this disease: venous, arterial, thromboembolic, hypoxic and mixed.
The development of pulmonary hypertension is due to the gradual narrowing of the lumen of the middle and small pulmonary vessels. The result of this narrowing is the complete closure of blood vessels, increased pressure in the vessels of the lungs, and the pumping function of the heart chambers worsens . Pulmonary hypertension belongs to the group of complex multidisciplinary diseases, and knowledge about them is constantly updated.
Pulmonary hypertension: symptoms.
Patients complain of general weakness, increased fatigue, shortness of breath, constricting pain and discomfort in the left half of the chest, fainting, and swelling of the legs. Symptoms may vary in intensity and depend on the severity of the disease. Four functional classes of pulmonary hypertension are distinguished. The group with the first class of pulmonary hypertension includes patients who have difficulty with strong physical exertion; the second class of hypertension includes patients who feel normal at rest, but even with moderate exertion they have shortness of breath, weakness, pain in the chest area and dizziness. Patients with a third class of pulmonary hypertension experience the above symptoms, even with domestic stress. The fourth class of pulmonary hypertension is classified in patients unable to bear the slightest physical exertion, and even at rest they suffer from weakness and shortness of breath.
An important place among the causes of pulmonary hypertension is the most common variant of lung disease - chronic bronchitis, which occurs in 90% of smokers. In addition, pulmonary hypertension is the most common complication of heart muscle damage in patients with heart defects, ischemic disease, and inflammatory myocardial diseases. Also, quite often this disease occurs in patients with various autoimmune pathologies, such as rheumatoid arthritis, lupus erythematosus and scleroderma.
Pulmonary hypertension: treatment and prevention.
The treatment of such a serious disease as pulmonary hypertension is one of the most difficult tasks of general practitioners and cardiologists. Currently, many specialized centers for the treatment and research of this pathology have been created around the world. Treatment of this disease includes measures aimed at reducing the likelihood of a worsening of the course of the disease. These include: pregnancy prevention, vaccination against pneumococcal infection and influenza, controlled rehabilitation, psychosocial support and dosing of physical activity.
The main goal in the treatment of pulmonary hypertension is to eliminate the cause of its occurrence, as well as reduce blood pressure in the pulmonary artery, and prevent blood clots. The course of treatment includes:
- reception of vasodilators, relaxing on the smooth muscle layer of blood vessels. These include prazosin, hydralazine and nifedipine;
- taking indirect anticoagulant drugs, the action of which is aimed at reducing blood viscosity - acetylsalicylic acid, dipyridamole, and others;
- oxygen inhalation during hypoxia and severe shortness of breath;
- taking diuretics.
In very severe cases, heart and lung transplantation is used.