Pulmonary hypertension life prognosis. Pulmonary hypertension: symptoms and treatment, dangers of the disease

Pulmonary hypertension (PH) is a disease in which the pressure in the pulmonary artery increases. Normally, systolic pressure in the pulmonary circulation should be 18-25 mm Hg, diastolic pressure should be 6-10 mm Hg, and the average specific pressure should be within 12-16 mm Hg. The diagnosis of pulmonary hypertension is made if the average specific pressure exceeds 30 mmHg. during physical activity and 25 mm Hg. at rest.

This disease significantly worsens the patient's condition and has a poor prognosis.. In some cases, it develops slowly, so patients may not realize they have pulmonary hypertension for a long time and begin treatment at a late stage. But remember that in any case, not all is lost: if you have been diagnosed with this disease, you can improve your condition thanks to special folk remedies. They reduce pressure in the pulmonary artery and relieve unpleasant symptoms.

Stages of pulmonary hypertension

So, we know what PH is, now it’s time to talk about its stages. Based on the pressure measured in the pulmonary artery, the disease is divided into three groups:

mild pulmonary hypertension - corresponds to an average specific pressure of 25-36 mmHg;
moderate pulmonary hypertension - pressure is 35-45 mm Hg;
severe pulmonary hypertension - pressure exceeds 45 mm Hg.

Naturally, the higher the severity of the disease, the worse its prognosis.

Causes and types of pulmonary hypertension

The cause of PH is a sustained increase in pressure in the pulmonary vessels. This may be due to the following factors:

heart disease, valve defects (mitral regurgitation) or Eisenmenger syndrome with congenital anomalies;
lung diseases such as pneumoconiosis (COPD), sleep apnea syndrome;
connective tissue diseases, such as systemic lupus erythematosus, etc.;
complications after pulmonary embolism;
other diseases that damage the pulmonary vessels (HIV infection, portal hypertension, poisoning with toxic drugs).

From the point of view of its causes, pulmonary hypertension is divided into 4 groups:

pulmonary arterial hypertension - mainly caused by connective tissue diseases, HIV infection, portal hypertension, heart defects;
venous pulmonary hypertension - develops as a result of diseases of the left valve or left ventricle of the heart;
pulmonary hypertension associated with respiratory diseases or hypoxia - mainly appears due to interstitial lung disease, COPD, sleep disturbances, chronic mountain sickness;
pulmonary hypertension associated with chronic thromboembolism - caused by blockage of the pulmonary arteries.

Primary pulmonary hypertension

The primary form is also sometimes referred to as idiopathic pulmonary hypertension. It occurs rarely (approximately 2 cases per million people) and its etiology is unknown. The disease is more often diagnosed in middle-aged women. Risk factors, in addition to the above, include a family history of hypertension, infectious diseases and portal hypertension.

Primary pulmonary hypertension occurs with vasospasm in the pulmonary circulation. In this case, excessive blood clotting is observed. The prognosis is very unfavorable. However, if you have been diagnosed with primary pulmonary hypertension, do not despair. Better pull yourself together and start treatment with folk remedies - this will help prolong your life for many years.

Secondary pulmonary hypertension

It develops against the background of other diseases - bronchial asthma, heart defects, pulmonary fibrosis, hypertension, systemic lupus erythematosus, etc. Thus, in order to get rid of PH, you must first cure the primary disease, if possible.

Symptoms

The first signs of pulmonary hypertension are a feeling of continuous fatigue and difficulty breathing, especially after physical activity. Patients have difficulty walking, climbing stairs, bending, and doing normal housework.

In later stages of the disease, the following symptoms appear:

dry cough;
hoarseness;
chest pain;
hemoptysis;
bluish tint of lips;
fainting;
cold extremities.

Pulmonary hypertension in newborns is manifested by retraction of pliable places on the chest, shortness of breath and severe bluishness of the skin. However, oxygen treatment does not produce any results.

Forecast and consequences

Any type of PH gives the same result: pulmonary vascular resistance increases. Such conditions force the right ventricle to work harder, leading to cardiac hypertrophy and dilatation within the right ventricle. As a result, congestive heart failure and mitral valve insufficiency develop. Excessive strain on the right ventricle due to lung disease is called cor pulmonale. These changes lead to a decrease in cardiac output, and if the disease is not treated, even to death.
The prognosis depends on the severity of PH. If you take care of yourself, follow some recommendations and carry out treatment, you can stop the development of the disease.

Treatment

So, you already know what pulmonary hypertension is and what its symptoms are. Now it's time to consider treatment.

If you have idiopathic (primary) pulmonary hypertension, palliative treatment is given, which allows you to prolong the patient’s life and improve its quality. With secondary pulmonary hypertension, the diseases that led to the problem are eliminated.

Below we will give patients lifestyle advice and introduce folk remedies that reduce pulmonary artery pressure.

Diet and lifestyle

Patients should avoid situations that worsen symptoms of the disease. Avoid physical exertion, do not climb to high altitudes, and do not fly in airplanes. If your health condition worsens, you can use breathing through oxygen cylinders.

It is important to try to avoid stress as it increases your blood pressure and heart rate. To combat stress, use meditation, walks in the fresh air, meeting with friends, hobbies and other suitable methods.

As for diet, the main rule here is to reduce salt intake. Replace it with other spices. Patients should also drink no more than 1.5 liters of water per day to avoid raising blood pressure. Naturally, alcohol and cigarettes are completely prohibited for this disease.

Garlic

Mild pulmonary hypertension can be completely cured with garlic. The fact is that this product expands the vessels of the pulmonary circulation, removes congestion in the veins, thereby reducing pressure. It is also very good for the heart, and it is heart problems that often lead to PH.

The simplest recipe is to eat 2 cloves of garlic every morning on an empty stomach with a glass of water. If you are afraid of bad breath, chew garlic with a mint leaf.

Garlic tea helps a lot. Don’t let such an exotic name scare you – this drink is very tasty and healthy. It will help restore not only the circulatory and respiratory systems, but also the entire body. Ingredients for one serving:

1 clove of garlic;
1 glass of water;
a little ground ginger (about 7-8 grams);
1 tablespoon lemon juice;
1 tablespoon honey.

Put the water on fire. When it starts to boil, add pre-chopped garlic clove, ginger and a spoonful of honey. Mix everything well and leave to simmer over low heat for about 20 minutes. Then strain the resulting infusion. Add a little lemon juice at the end. We recommend drinking this tea on an empty stomach twice a day.

Clover

Clover is very beneficial for the cardiovascular system and will help with your illness. It can be used in many ways.

If possible, plant clover in a pot at home and eat the young shoots of this plant. A tablespoon of herb will be enough.

You can also make tea from dried clover flowers. For a glass of water you will need a teaspoon of crushed plant. Pour boiling water over the clover, leave for 15 minutes, then drink. Take 2-3 glasses of this drug per day.

Digitalis

Foxglove will save you from chest pain and severe shortness of breath, but you need to drink it carefully, increasing the dosage and monitoring the condition of the body.

Prepare an alcohol tincture at the rate of 1 part of dry foxglove herb to 10 parts of alcohol with a strength of 70 degrees. Leave the mixture for 2 weeks, then strain. Start with a dosage of 3 drops twice daily. The tincture should be dissolved in a small amount of water and drunk on an empty stomach. After about a week, the dosage can be increased to 5 drops, then after another week - to 7 drops. Then move on to 10 drops of the tincture twice daily. The course of treatment lasts from 2 to 4 months.

Hawthorn

Hawthorn dilates blood vessels, helping to reduce systolic and diastolic pressure in the pulmonary artery. It can be used in several ways.

The first method is tea. To prepare the drink, pour a dessert spoon of dried hawthorn flowers and leaves into a mug and pour a glass of boiling water. Keep the glass covered for 15 minutes, then strain the drink. You should drink 1 glass in the morning and evening.

The second method is healing wine. You will need 50 g of ripe hawthorn fruits and 500 ml of natural sweet red wine. Crush the berries in a mortar, heat the wine to a temperature of about 80 C. Pour warm wine into a glass jar or bottle, add hawthorn, close the lid and leave for 2 weeks, then strain. Drink 25 ml of this wine every evening before bed.

The third method is alcohol tincture. Combine hawthorn flowers with alcohol in a ratio of 1 to 10 and leave in a glass container for 10 days, then strain. Drink about half a teaspoon of this tincture in the morning and evening on an empty stomach.

Mistletoe

It will be much easier for the patient if he starts taking mistletoe. In the evening, pour a teaspoon of herbs with a glass of cold water, let the mixture steep overnight. In the morning, warm it slightly and drink it. This should be done every day.

You can also make wine from mistletoe. You will need 50 g of the plant and 500 ml of dry white wine. Combine these components and leave for 1 week, then strain. Take 25 ml twice daily before meals.

Rowan fruits

Rowan fruits have a beneficial effect on the cardiovascular system. Therefore, replace regular tea with tea from this plant. Mash a tablespoon of fruit in a mug, add a small amount of sugar and 200 ml of boiling water. Stir and drink. It is recommended to take 3 servings of this tea per day.

Witchcraft collection

There is a good collection of plants that is recommended by experienced healers. Combine equal parts of adonis herb, valerian root, mint leaves, St. John's wort herb and dill seeds. Brew a tablespoon of this mixture with a liter of boiling water in a thermos overnight and leave until morning. This will be your portion for the whole day; you need to drink the infusion in between meals. Continue the course of treatment for 2 months, then you need to take a break for at least 2 weeks.

Treatment with juices and smoothies

Juice is a natural healer that will help cope with many problems, including PH. We will give some of the most effective recipes.

Juice for the heart

With pulmonary hypertension, it is necessary to support the work of the heart. To do this, prepare the following mix:

2 cups red grapes;
1 grapefruit;
1 teaspoon crushed linden flowers;
¼ teaspoon cloves, crushed into powder.

Combine all these ingredients and mix in a blender. You need to drink the smoothie immediately after preparing it; it is recommended to take a glass a day. Within weeks you will notice positive changes.

Juice to normalize blood pressure

Connect the following components:

juice of 1 grapefruit;
juice from 2 oranges;
6 sprigs of fresh parsley;
2 tablespoons of hawthorn flowers;
3 peeled and chopped kiwis.

Mix everything in a blender and drink immediately after preparation. Take this remedy in the morning and evening so that your blood and pulmonary pressure are always normal.

Juice for shortness of breath

If you are tormented by shortness of breath, conduct a month-long course of treatment with the following juice:

5-6 fresh dandelion leaves;
1 tablespoon red clover flowers;
1 red apple;
1 cup chopped Brussels sprouts;
1 large carrot;
0.5 cups chopped parsley.

Squeeze the juice out of the apple, carrots and Brussels sprouts, mix the juices, add parsley, red clover and finely chopped dandelion leaves. Take the juice on an empty stomach, 1 glass twice a day.

Juice to improve overall well-being

You will need:

half a melon;
1 cup fresh strawberries;
a piece of ginger root 2.5 cm long;
1 orange;
1 grapefruit;
¼ cup natural yogurt (no additives);
half a handful of wheat sprouts.

Squeeze juice from orange, melon, strawberry and grapefruit. Grate the ginger. Combine the juices, add ginger, yogurt and wheat sprouts. Drink to your health!

Pulmonary hypertension (PH) is an increase in the average pressure in the pulmonary artery to 25 mm Hg. Art. and more.

The result is an increase in resistance in the bloodstream, impaired nutrition of the right ventricle of the heart and the development of serious complications in all organs and systems due to severe hypoxia.

In 80% of cases (data from the European Society of Cardiology), death occurs.

Moreover, the prospects for such a scenario are characterized by a number of 3-10 years, sometimes less if the main process is aggressive.

The patient population is young women under 40 years of age. According to statistics, the ratio of the fairer sex to men is characterized as 4-5:1. The mortality rate among the strong part of humanity, however, is several times higher.

The asymptomatic course and lack of specific manifestations lead to the diagnosis being made at a late stage, when it is almost impossible to help. And sometimes even based on the results of a pathological examination.

Specific preventive measures have not been developed, as well as early screening methods.

The pathological condition is preceded by stenosis or narrowing of the lumen of blood vessels, including small branches and medium-sized structures extending from the pulmonary artery.

The endothelium, that is, the inner lining of the blood vessels, thickens. This is an adaptive mechanism.

The pressure in the pulmonary artery increases progressively, rapidly, the load on the right ventricle increases, which leads to its hypertrophy (thickening).

Contractility decreases, and symptoms of heart failure increase. A classic pathological process is formed -.

It happens differently for everyone, but a favorable outcome is not always found.

Risk factors

Pulmonary hypertension is a mystery for both pulmonologists and cardiologists. Pathogenesis has not been established. We can only talk about factors that increase the risk of a pathogenic process.

Taking oral contraceptives

Destroys normal hormonal levels to the core. Estrogen-gestagen drugs provoke an artificial drop in progesterone, which is partly responsible for the adequate inhibition of proliferative processes in the body (disturbs the division of some cells); it is also this substance that contributes to the stable regulation of vascular tone in the fairer sex.

An increase in estrogen provokes inflammatory processes and aggravates the course of hypertension. Apparently, this is due to the higher prevalence in women.

Severe and prolonged increase in blood pressure

Pulmonary problems can become a complication of cardiovascular disease. This is a natural outcome if left untreated or given the wrong therapy.

Doctors are partly to blame for their inability to make a correct diagnosis and react in time to the impending threat.

Family history

In most cases it does not matter. Because diseases themselves are not inherited. At the same time, other generations receive features of the circulatory and immune systems from previous ones.

Blood pressure is observed in almost all descendants of a person suffering from hypertension. It is possible to prevent the development of diseases as part of prevention, but few people pay attention to this issue.

Interesting:

The potential for the formation of pathologies of the cardiovascular system is determined by the number of sick relatives and gender: women are most susceptible due to genetic characteristics.

Pulmonary hypertension in such a situation becomes secondary, developing as a result of a long-term increase in blood pressure or autoimmune pathologies.

Problems with the body's defenses

Diseases such as rheumatoid arthritis, systemic lupus erythematosus, Hashimoto's thyroiditis, and other autoimmune pathologies affect the likelihood of developing pulmonary hypertension.

According to statistics, patients with the described diagnoses suffer almost three times more often than relatively healthy people. A similar correlation was noted 20-30 years ago.

Thus, pulmonary hypertension is idiopathic. It is difficult, if not impossible, to determine the specific reasons for the development of the condition.

Specific research on this issue is still underway. Determining the etiology and pathogenesis will allow us to develop effective therapeutic tactics, early screening and prevention measures.

Despite all that has been said, the disease is considered low-common and is diagnosed in 7-13% of clinical situations, which is not so much.

The main factors in the development of the disease in patients

The reasons are also not fully understood. It was partially possible to identify some pathologies that could lead to the development of secondary pulmonary hypertension.

Among them:

Congestive heart failure. Disruption of the atria and ventricles as a result of poor nutrition or other factors. Often ends in myocardial infarction.

But one does not interfere with the other. Acute circulatory disorders can be combined with increasing symptoms of pulmonary hypertension.

. It says the same thing.

Congenital and acquired heart defects. As a result of improper operation (for example, with), the load on the arteries is distributed unevenly. This often leads to pathological expansion of the endotheolium (internal lining of the vessel), hypertrophy.

Chronic obstructive pulmonary disease. A destructive process that sooner or later comes to smokers and workers in hazardous industries.

Determined by a mass of symptoms, pulmonary hypertension is a late consequence of the disease, a particularly formidable complication, at the same time the quietest and most unnoticeable.

Chronic thrombosis of the pulmonary artery and its branches. This is due to partial blockage of the lumen by pathological objects: blood clots, air bubbles. The first is much more common.

The process must be treated urgently, since partial blockage can become complete.

Hence, circulatory disorders, acute changes in the nature of cardiac activity and death within a few minutes.

Hypoventilation of the lungs. As a result of a long course of pathologies of the respiratory system: from destructive bronchitis to asthma, and other processes of the same kind. The underlying cause is being treated.

Etiotropic therapy should not harm the cardiovascular system. Often, pulmonologists and allergists thoughtlessly prescribe glucocorticoids, completely regardless of the consequences.

And similar ones are very common. Including an increase in pressure in the pulmonary artery and aorta.

Myocarditis. Inflammatory pathology of the heart (middle muscular layer of the organ). It occurs as a complication of infectious diseases, less often as a primary phenomenon. It is provoked by pyogenic flora.

Cirrhosis. Acute hepatonecrosis. In other words, a destructive process affecting hepatocytes (organ cells).

Most often found in experienced alcoholics. Less common in patients with hepatitis B, C, suffering from drug intoxication.

The lungs are not the first to suffer; this is a symptom of a developed disease, when the destructive process reaches 40-50% of the total liver volume.

The compensated form has lower risks, although it cannot be written off.

HIV infection. Due to the development of weakened immunity to critical levels, almost all patients with AIDS are observed (one in three suffers). This is another factor in the early death of patients of this profile.

Clinical classification of the pathological process

Pulmonary hypertension can be subdivided on different grounds. Both typologies presented below are recognized in medical practice.

Depending on the degree of restrictions and severity of the process, several classes are distinguished:

First . Characterized by minimal changes in organs and systems. Pulmonary hypertension of the 1st degree is the most favorable moment for treatment, but identifying the pathology is incredibly difficult. You need to look specifically, because due to the absence of symptoms, it is not immediately possible to suspect a problem.
Second . The changes are already more pronounced. The heart thickens, but only slightly. Physical activity decreases slightly, symptoms are minimal. At this stage, it is still possible to reverse the process without any special consequences for the patient’s body, but complex treatment in a hospital setting is already required.
Third . The symptoms are quite obvious. But it is still nonspecific, which prevents timely diagnosis and verification. A competent professional will be able to suspect something is wrong just by sight; it is enough to conduct specialized research.
Fourth . Extreme, terminal stage. The clinical picture is obvious, but even in this situation there are no characteristic symptoms. The process can easily be confused with classic hypertension. The diagnosis is made precisely at this moment, and a little more often during the autopsy.

The generally accepted classification, however, does not answer where the process comes from. This issue is resolved by the second typification, depending on the etiology.

Accordingly, they distinguish:

Hereditary factor. Disputes about the impact of such a moment have been going on for many years, and will continue for just as long. Genetic predisposition appears to be of great importance.
Idiopathic etiology. This diagnosis is made when it is impossible to understand the situation. That is, the clinic is obvious, the reasons are not clear.
Associated form. Characterized by secondary nature. It develops as a result of the formation of one or another pathological process that causes the disease.
Persistent. Appears in newborns, but the formation factors are also not clear. There is a likely connection between the perinatal period and the problem.
Medicinal or toxic. As a result of long-term use of corticosteroids, tonics and some other complex drugs with devastating side effects.

Other possible groups of drugs: antidepressants and mood stabilizers, antipsychotics, especially the older generation, typical ones, ibuprofen and anti-inflammatory drugs of non-steroidal origin, antibiotics and, already mentioned at the beginning of the material, oral contraceptives.

Taking psychoactive substances also has an effect. Drugs such as cocaine and amphetamine hit the lung structures, heart and blood vessels hard.

Even short-term use makes itself felt by adverse effects of this kind.

Pulmonary hypertension is formed as a response to a pathological process; it is rare as a primary disease. The exact percentage is not known.

Symptoms, general and depending on stage

Among the manifestations typical for all stages of the pathological process:

Shortness of breath for no apparent reason. The lungs cannot function properly as a result of poor circulation.
Hypoxia and disruption of cellular metabolism leads to inhibition of ATP synthesis. Hence muscle weakness, inability to move normally, fatigue and other manifestations of a similar kind.
Cough. Persistent, without mucus production, unproductive and dry. Always accompanies pulmonary hypertension.
Hoarseness, inability to control the voice.
Tachycardia as a result of disruption of the normal supply of blood and nutrients to the heart.
Fainting.
Ischemia of cerebral structures and, accordingly, dizziness, cephalalgia, nausea, vomiting. Up to the phenomenon of stroke.
Edema of the lower extremities.
Pain in the right hypochondrium. They can be primary, as a result of liver damage, or secondary, as a result of the involvement of the organ in the pathological process.

The absence of specific manifestations leads to the impossibility of timely diagnosis. On the other hand, a pronounced clinical picture is formed when the pressure in the vessel increases by 2 times compared to normal values.

Stage 1. Physical activity does not change. Intense loads lead to dizziness, cephalalgia, shortness of breath, and minor tissue hypoxia.
Stage 2. Slight decrease in physical activity. The patient can still carry out normal daily activities. But with some restrictions. The result is shortness of breath, palpitations, and muscle problems.
Stage 3. Significant reduction in strength. Minimum activity is also impossible.
Stage 4. Symptoms appear even in a state of complete rest.

Moderate pulmonary hypertension is the optimal time to start therapy. Catastrophic consequences have not yet arrived, and the signs are quite pronounced.

It is even better to carry out specific treatment at the very beginning of the condition. Symptoms of pulmonary hypertension develop in the lungs, blood vessels, and heart.

Diagnostics

Patients with suspected pulmonary hypertension are examined by a pulmonologist and a cardiologist in tandem. The diagram of diagnostic measures looks like this:

Questioning the patient. Usually the first complaint that people make is severe shortness of breath, pressing discomfort in the chest.
Anamnesis collection. Heredity plays a big role, as already mentioned.
Visual data exploration. In patients with pulmonary hypertension, deformation of the distal phalanges of the fingers and nails is observed according to a specific type.
Listening to breathing sounds. The weakening of tones and their splitting are determined.
Electrocardiography. To assess the general condition of the heart and the intensity of its work. It is carried out at the very first moment. Allows you to notice minimal deviations.
Echocardiography. Right ventricular hypertrophy is detected.
Tomography, primarily computed tomography. The pulmonary arteries become enlarged and dilated, which is specific to the condition in question. Changes in the heart are detected.
X-ray of the lungs. Not informative enough, but more accessible.
Arterial catheterization. Performed with care, it allows you to quickly measure the pressure inside an anatomical structure.
Angiopulmonography.
Assessment of the tonometer indicator is routine (using a household device).
Finally, 24-hour monitoring may be required.

The diagnostic scheme is approximately as follows. The order may be changed at the discretion of leading specialists.

Treatment is medicinal

Carried out as a primary measure. The following pharmaceutical groups are prescribed:

Vasodilators. Normalize the muscle layer. But they must be used with caution, since there is a high risk of sudden re-stenosis with worsening of the condition. Dosages and names are selected by a group of doctors.
Diuretics. They allow you to “drive away” excess fluid and normalize blood pressure.
Oxygen inhalations to compensate for the lack of substance during natural breathing.
Statins. Allows you to fight the atherosclerotic process, if any. In most cases it is, which aggravates the already difficult situation of the patient.
Anticoagulants. Normalizes the rheological properties of blood. Used with caution due to the possibility of fatal internal bleeding.

Conservative treatment of pulmonary hypertension is effective at stages 1-2, when the disease has not yet reached the terminal stage. Specific names of medications are selected by the attending physicians caring for the patient.

It is necessary to choose the right dosage and combination; it is better to do this in a hospital setting (pulmonology or cardiology).

Surgical treatment

Indicated when conservative methods are ineffective. Consists of lung and heart transplantation. At the moment, in the conditions of Russian reality and the realities of the CIS countries, it is almost impossible to wait in line for such an operation.

In other states, everything is also not rosy, which is due to the imperfection of medical legislation and, as a result, a small number of potential donors.

Pulmonary thromboendarterectomy is prescribed as a surgical measure for thromboembolism.(an operation to remove a blood clot from the initial branches of the pulmonary artery).

The method allows you to remove the load from the right ventricle, but it is only feasible until the blood clot begins to degenerate into connective tissue.

Forecast

The primary form of pulmonary hypertension is unfavorable, even too unfavorable. Patients live no more than 1-2 years.

Secondary is easier, especially with a favorable response to the therapy. There is a chance for compensation and good survival.

With a long-term process with persistently high pressure in the pulmonary artery, the patient dies within 5 years.

In conclusion

Pulmonary hypertension is a dangerous complication of many diseases. It requires a serious approach and assistance from a whole group of specialists.

You can’t delay diagnosis; every day counts. If not started promptly, death is almost guaranteed in the short term.

Pulmonary hypertension- this is a certain state of the pulmonary system, during which intravascular pressure sharply increases in the blood flow of the pulmonary artery. It is interesting that pulmonary hypertension develops due to the influence of one of two main pathological processes: both due to a sharp increase in the volume of the blood flow itself and a subsequent increase in pressure due to the increased blood volume, and due to an increase in the intravascular pulmonary pressure itself with an unchanged blood flow volume. It is customary to speak of the occurrence of pulmonary hypertension when the pressure in the pulmonary artery exceeds 35 mmHg.

Pulmonary hypertension is a complex, multicomponent pathological condition. During its gradual development and disclosure of all clinical signs, the cardiovascular and pulmonary systems are gradually affected and destabilized. Advanced stages of pulmonary hypertension and its individual forms, characterized by high activity (for example, forms of idiopathic pulmonary hypertension or pulmonary hypertension in certain autoimmune lesions), can result in the development of respiratory and cardiovascular dysfunction and subsequent death.

You need to understand that the survival of patients with pulmonary hypertension directly depends on timely diagnosis and drug therapy of the disease. Therefore, it is necessary to clearly define the first key signs of pulmonary hypertension and the stages of its pathogenesis in order to prescribe timely therapy.

Primary or idiopathic (of unknown origin) pulmonary hypertension is currently the most poorly studied subtype of pulmonary hypertension. Its main causes of development are based on genetic disorders that manifest themselves during the embryonic formation of future vessels supplying the pulmonary system. In addition, due to the same effect of genome defects, the body will experience insufficient synthesis of certain substances that can narrow or, on the contrary, dilate blood vessels: endothelial factor, serotonin and the special factor angiotensin 2. In addition to the two factors described above, which are prerequisites for primary pulmonary hypertension, There is also another prerequisite factor: excessive platelet aggregation activity. As a result, many small vessels in the pulmonary circulatory system will be clogged with blood clots.

As a result, the intravascular pressure in the pulmonary circulatory system will sharply increase, and this pressure will act on the walls of the pulmonary artery. Since the arteries have a more reinforced muscle layer, in order to cope with the increasing pressure in their bloodstream and “push” the required amount of blood further through the vessels, the muscular part of the wall of the pulmonary artery will increase - its compensatory hypertrophy will develop.

In addition to hypertrophy and minor thrombosis of the pulmonary arterioles, the development of primary pulmonary hypertension may also involve a phenomenon such as concentric fibrosis of the pulmonary artery. During this, the lumen of the pulmonary artery itself will narrow and, as a result, the pressure of the blood flow in it will increase.

As a consequence of high blood pressure, the inability of normal pulmonary vessels to support the advancement of blood flow with an already higher than normal pressure, or the inability of pathologically altered vessels to promote the advancement of blood flow with normal pressure levels, another compensatory mechanism will develop in the pulmonary circulatory system - the so-called “ bypass paths,” namely, arteriovenous shunts will open. By transferring blood through these shunts, the body will try to reduce the high level of pressure in the pulmonary artery. But since the muscular wall of the arterioles is much weaker, very soon these shunts will fail and multiple areas will form, which will also increase the pressure value in the pulmonary artery system during pulmonary hypertension. In addition, such shunts disrupt the proper flow of blood through the circulation. During this process, the processes of blood oxygenation and oxygen supply to tissues are disrupted.

With secondary hypertension, the course of the disease is slightly different. Secondary pulmonary hypertension is caused by a huge number of diseases: chronic obstructive lesions of the pulmonary system (for example COPD), congenital heart defects, thrombotic lesions of the pulmonary artery, hypoxic conditions (Pickwick syndrome) and, of course, cardiovascular diseases. Moreover, cardiac diseases that can lead to the development of secondary pulmonary hypertension are usually divided into two subclasses: diseases that cause insufficiency of left ventricular function, and those diseases that will lead to increased pressure in the chamber of the left atrium.

The underlying causes of pulmonary hypertension that accompany the development of left ventricular failure include ischemic damage to the left ventricular myocardium, its cardiomyopathic and myocardial damage, defects of the aortic valve system, coarctation of the aorta, and the effect of arterial hypertension on the left ventricle. Diseases that cause increased pressure in the left atrium chamber and the subsequent development of pulmonary hypertension include mitral stenosis, tumor lesions of the left atrium, and developmental anomalies: triatrial anomalous heart or the development of a pathological fibrous ring located above the mitral valve (“supravalvular mitral annulus”).

During the development of secondary pulmonary hypertension, the following main pathogenetic links can be distinguished. They are usually divided into functional and anatomical. The functional mechanisms of pulmonary hypertension develop due to disruption of normal or the emergence of new pathological functional features. Subsequent drug therapy will be aimed at their elimination or correction. The anatomical mechanisms for the development of pulmonary hypertension arise due to certain anatomical defects in the pulmonary artery itself or the pulmonary circulatory system. It is almost impossible to cure these changes with drug therapy; some of these defects can be corrected through certain surgical procedures.

The functional mechanisms of the development of pulmonary hypertension include the pathological Savitsky reflex, an increase in minute blood volume, the effect of biologically active substances on the pulmonary artery and an increase in the level of intrathoracic pressure, an increase in blood viscosity and the impact of frequent bronchopulmonary infections.

Savitsky's pathological reflex develops in response to obstructive bronchial lesions. With bronchial obstruction, spastic compression (constriction) of the branches of the pulmonary artery occurs. As a result, intravascular pressure and resistance to blood flow in the pulmonary circulation increases significantly in the pulmonary artery. As a result, the normal flow of blood through these vessels is disrupted, slows down, and the tissues do not receive oxygen and nutrients in full, resulting in hypoxia. In addition, pulmonary hypertension causes hypertrophy of the muscular layer of the pulmonary artery itself (as discussed above) as well as hypertrophy and dilatation of the right heart.

Minute blood volume in pulmonary hypertension occurs as a response to the hypoxic consequences of increased intravascular pressure in the pulmonary artery. Low oxygen content in the blood affects certain receptors that are located in the aortic-carotid zone. During this effect, the amount of blood that the heart can pump through itself in one minute (minute blood volume) automatically increases. At first, this mechanism is compensatory and reduces the development of hypoxia in patients with pulmonary hypertension, but very quickly the increased volume of blood that will pass through the narrowed arteries will lead to an even greater development and aggravation of pulmonary hypertension.

Biologically active substances are also produced due to the development of hypoxia. They cause spasm of the pulmonary artery and an increase in aortic-pulmonary pressure. The main biologically active substances that can narrow the pulmonary artery are histamines, endothelin, thromboxane, lactic acid and serotonin.

Intrathoracic pressure most often occurs with broncho-obstructive lesions of the pulmonary system. During these lesions, it rises sharply, compresses the alveolar capillaries and contributes to increased pressure in the pulmonary artery and the development of pulmonary hypertension.

As blood viscosity increases, the ability of platelets to settle and form blood clots increases. As a result of this, changes similar to those in the pathogenesis of primary hypertension develop.

Frequent bronchopulmonary infections have two effects on the aggravation of pulmonary hypertension. The first way is a violation of pulmonary ventilation and the development of hypoxia. The second is the toxic effect directly on the myocardium and the possible development of myocardial lesions of the left ventricle.

The anatomical mechanisms of the development of pulmonary hypertension include the development of the so-called reduction (decrease in the number) of vessels of the pulmonary circulation. This occurs due to thrombosis and sclerosis of small vessels of the pulmonary circulation.

Thus, we can distinguish the following main stages in the development of pulmonary hypertension: an increase in the level of pressure in the pulmonary artery system; disruption of nutrition of tissues and organs and the development of their hypoxic lesions; hypertrophy and dilatation of the right heart and the development of “pulmonary heart”.

Pulmonary hypertension symptoms

Since pulmonary hypertension is by its nature a rather complex disease and develops during the action of certain factors, its clinical signs and syndromes will be very diverse. It is important to understand that the first clinical signs of pulmonary hypertension will appear when the pressure in the bloodstream of the pulmonary artery is 2 or more times higher than normal values.

The first signs of pulmonary hypertension are the appearance of shortness of breath and hypoxic organ damage. Shortness of breath will be associated with a gradual decrease in the respiratory function of the lungs, due to high intra-aortic pressure and reduced blood flow in the pulmonary circulation. Dyspnea with pulmonary hypertension develops quite early. At first it occurs only as a result of exposure to physical activity, but very soon it begins to appear independently of them and becomes permanent.

In addition to shortness of breath, hemoptysis also very often develops. Patients may notice the release of a small amount of sputum streaked with blood when coughing. Hemoptysis occurs due to the fact that, as a result of the effects of pulmonary hypertension, blood stagnation occurs in the pulmonary circulation. As a result, some of the plasma and red blood cells will sweat through the vessel and the appearance of individual blood streaks in the sputum.

When examining patients with pulmonary hypertension, one can detect cyanosis of the skin and characteristic changes in the phalanges of the fingers and nail plates - “drumsticks” and “watch glasses”. These changes occur due to insufficient tissue nutrition and the development of gradual degenerative changes. In addition, “drumsticks” and “watch glasses” are a clear sign of bronchial obstruction, which can also be an indirect sign of the development of pulmonary hypertension.

Auscultation can detect increased pressure in the pulmonary artery. This will be evidenced by an increase in 2 tones heard through a stethoscope in the 2nd intercostal space on the left - the point where the pulmonary valve is usually heard. During diastole, the blood passing through the pulmonary valve encounters high blood pressure in the pulmonary artery and the sound that is heard will be much louder than normal.

But one of the most important clinical signs of the development of pulmonary hypertension will be the development of the so-called pulmonary heart. Cor pulmonale is a hypertrophic change in the right heart that develops in response to the effects of increased blood pressure in the pulmonary artery. This syndrome is accompanied by a number of objective and subjective signs. Subjective signs of cor pulmonale syndrome in pulmonary hypertension will be the presence of constant pain in the heart area (cardialgia). These pains will disappear with oxygen inhalation. The main reason for this clinical manifestation of cor pulmonale is hypoxic damage to the myocardium, during the disruption of oxygen transport to it due to high pressure in the pulmonary circulatory system and high resistance to normal blood flow. In addition to pain, pulmonary hypertension may also include strong and periodic palpitations and general weakness.

In addition to subjective signs, which cannot be used to fully assess the presence or absence of pulmonary heart syndrome in a patient with pulmonary hypertension, there are also objective signs. By percussion of the heart area, a displacement of its left border can be determined. This occurs due to the enlargement of the right ventricle and its displacement of the left parts beyond the normal boundaries of percussion. Also, an increase in the right ventricle due to its hypertrophy will lead to the fact that it will be possible to determine the pulsation or the so-called cardiac impulse along the left border of the heart.

With decompensation of the pulmonary heart, signs of liver enlargement will develop and the neck veins will swell. In addition, a characteristic indicator of decompensation of the pulmonary heart will be a positive Plesh symptom - when pressing on the enlarged liver, simultaneous swelling of the neck veins will appear.

Pulmonary hypertension degree

Pulmonary hypertension is classified according to many different criteria. The main signs of the classification of pulmonary hypertension by stages are the degree of development of the cor pulmonale, ventilation disturbances, the degree of hypoxic tissue damage, hemodynamic disturbances, radiological and electrocardiographic signs.

It is customary to distinguish 3 degrees of pulmonary hypertension: transient, stable and stable with severe circulatory failure.

Grade 1 (transient degree of pulmonary hypertension) is characterized by the absence of clinical and radiological signs. At this stage, primary and minor signs of external respiration failure will be observed.

Stage 2 pulmonary hypertension (stable stage of pulmonary hypertension) will be accompanied by the development of shortness of breath, which will occur with previously habitual physical activity. In addition to shortness of breath, acrocyanosis will be observed at this stage. Objectively, an enhanced apical cardiac impulse will be determined, which will indicate the beginning formation of the pulmonary heart. Auscultation with 2nd degree of pulmonary hypertension will already be possible to listen to the first signs of increased pressure in the pulmonary artery - the above-described emphasis of 2nd tone at the point of auscultation of the pulmonary artery.

On a general x-ray of the thoracic region, one can see a bulging of the contour of the pulmonary artery (due to high pressure in it), expansion of the roots of the lungs (also due to the effect of high pressure in the vessels of the pulmonary circulation). The electrocardiogram will already show signs of overload on the right side of the heart. When examining the function of external respiration, a tendency towards the development of arterial hypoxemia (a decrease in the amount of oxygen) will be observed.

In the third stage of pulmonary hypertension, diffuse cyanosis will be added to the clinical signs described above. Cyanosis will be a characteristic shade - gray, “warm” type of cyanosis. Swelling, painful enlargement of the liver and swelling of the neck veins will also appear.

Radiologically, in addition to the signs inherent in stage 2, the expansion of the right ventricle visible on the radiograph will also be added. The electrocardiogram will show increased signs of right heart overload and right ventricular hypertrophy. When examining respiratory function, severe hypercapnia and hypoxemia will be observed, and metabolic acidosis may also occur.

Pulmonary hypertension in newborns

Pulmonary hypertension can develop not only in adulthood, but also in newborns. The cause of this condition lies in the characteristics of the pulmonary system of a newborn child. At his birth, a sharp jump in intravascular pressure occurs in the pulmonary artery system. This jump occurs due to blood flow to the opened lungs and the start of pulmonary circulation. It is this sharp jump in pressure in the pulmonary artery that is the primary cause of the development of pulmonary hypertension in a newborn child. With it, the circulatory system is not able to reduce and stabilize the spontaneous increase in intravascular pressure when the child takes his first breath. As a result, decompensation of the pulmonary circulation occurs and characteristic changes of pulmonary hypertension occur in the body.

But pulmonary hypertension can also occur after a sharp rise in pressure in the pulmonary circulatory system. If, after such a jump, the vascular pulmonary system of the newborn turns out to be unadapted to the new physiological level of intravascular pressure in it, then this can also lead to pulmonary hypertension.

As a result of these reasons, a special compensation mechanism is launched in the body, during which it tries to reduce the pressure that is too high for it. This mechanism is similar to that of shunts in adult pulmonary hypertension. Since the fetal blood flow tracts have not yet closed in the newborn child, a large shunt is automatically triggered with this type of pulmonary hypertension - the blood is discharged through the not yet closed opening through which the fetus was supplied with oxygen from the mother - the fetal ductus arteriosus.

It is customary to speak of the presence of severe pulmonary hypertension in a newborn child when there is an increase in intra-arterial pulmonary pressure above 37 mm. RT Art.

Clinically, this type of arterial hypertension will be characterized by the rapid development of cyanosis and impaired respiratory function of the child. In addition, the appearance of severe shortness of breath will come to the fore. It is important to note that this type of pulmonary hypertension in a newborn child is an extremely life-threatening condition - in the absence of prompt treatment, the death of a newborn can occur within a matter of hours from the moment of the first manifestations of the disease.

Pulmonary hypertension treatment

Treatment of pulmonary hypertension is aimed at eliminating the following factors: high intra-arterial pulmonary pressure, prevention of thrombosis, relief of hypoxia and unloading of the right side of the heart.

One of the most effective treatments for pulmonary hypertension is the use of calcium channel blockers. The most commonly used drugs from this line of drugs are Nifedipine and Amlodipine. It is important to note that 50% of patients with pulmonary hypertension with long-term therapy with these drugs experience a significant reduction in clinical symptoms and improvement in general condition. Therapy with calcium channel blockers is started initially with low doses and then gradually increased to a high daily dose (about 15 mg per day). When prescribing this therapy, it is important to periodically monitor the average level of blood pressure in the pulmonary artery in order to adjust the therapy.

When choosing a calcium channel blocker, it is also important to consider the patient's heart rate. If bradycardia is diagnosed (less than 60 beats per minute), then Nifedipine is prescribed to treat pulmonary hypertension. If tachycardia of 100 beats per minute or higher is diagnosed, then the optimal drug for the treatment of pulmonary hypertension is Diltiazem.

If pulmonary hypertension does not respond to therapy with calcium channel blockers, then treatment with prostaglandins is prescribed. These drugs trigger the expansion of narrowed pulmonary vessels and prevent platelet aggregation and the subsequent development of thrombosis in pulmonary hypertension.

In addition, patients with pulmonary hypertension are periodically prescribed oxygen therapy. They are carried out when the partial pressure of oxygen in the blood decreases below 60-59 mmHg.

In order to unload the right side of the heart, diuretics are prescribed. They reduce the volume overload of the right ventricle and reduce the stagnation of venous blood in the systemic circulation.

It is also important to periodically administer anticoagulant therapy. The drug Warfarin is used most often for these purposes. It is an indirect anticoagulant and prevents thrombus formation. But when prescribing Warfarin, it is necessary to monitor the so-called international normal ratio - the ratio of the patient’s prothrombin time to the established norm. To use Warfarin for pulmonary hypertension, INR levels should be in the range of 2-2.5. If this index is lower, then the risk of developing massive bleeding is extremely high.

Pulmonary hypertension prognosis

The prognosis of pulmonary hypertension is generally unfavorable. Approximately 20% of reported cases of pulmonary hypertension are fatal. The type of pulmonary hypertension is also an important prognostic sign. Thus, with secondary pulmonary hypertension, which arises as a result of autoimmune processes, the worst prognosis for the outcome of the disease is observed: about 15% of all patients with this form die within a few years after diagnosis from gradually developing insufficiency of pulmonary function.

An important factor that can determine the life expectancy of a patient with pulmonary hypertension is also the average pressure in the pulmonary artery. If this indicator increases above 30 mmHg and if it is highly stable (lack of response to appropriate therapy), the average life expectancy of the patient will be only 5 years.

In addition, the time of onset of signs of cardiac failure also plays an important role in the prognosis of the disease. If signs of class 3 or 4 heart failure are detected and signs of development of right ventricular failure, the prognosis of pulmonary hypertension is also considered extremely unfavorable.

Idiopathic (primary) pulmonary failure also has poor survival. It is extremely difficult to treat, and with this form of pulmonary hypertension it is almost impossible to influence with therapy the factor that directly causes a sharp increase in pressure in the bloodstream of the pulmonary artery. The average life expectancy of such patients will be only 2.5 years (on average).

But in addition to the large number of negative prognostic indicators for pulmonary hypertension, there are also several positive ones. One of them is that if, when treating pulmonary hypertension with calcium channel blockers, the signs of the disease gradually disappear (that is, the disease responds to this therapy), then the survival rate of patients in 95% of cases will exceed the five-year threshold.

Hypertension - what is it? Pulmonary hypertension is often diagnosed in older people. Among diseases of the vascular system, this pathology ranks 3rd.

First of all, it is worth noting that pulmonary hypertension is not an independent disease, but a consequence of pathologies in the pulmonary vessels that lead to an increase in blood volume. As a result, blood pressure in the pulmonary artery increases.

What causes primary hypertension?

Despite the fact that in most cases these are consequences of another disease, the pathology can be congenital. It is this form that is diagnosed in children. It is called primary.

Primary pulmonary hypertension is poorly understood to date. Its main cause is genetic disorders in the embryo that arose during the formation of the vascular system. This not only leads to increased pressure in the pulmonary artery, but also causes disruptions in the production of certain substances in the body, such as serotonin.

Primary pulmonary hypertension may also result from elevated platelet levels. The blood vessels become blocked by blood clots, resulting in increased blood pressure. In addition to thrombosis, idiopathic pulmonary hypertension occurs due to narrowing of the lumens in the blood vessels. This phenomenon is called pulmonary fibrosis.

If the disease is not diagnosed in time, then lack of treatment will lead to even greater problems. The body, trying to relieve pressure in the pulmonary artery, throws excess blood to the arteriovenous shunts. Opening a "workaround" helps buy time. However, shunts are much weaker than vessels and wear out quickly, which leads to an even greater increase in pressure.

In addition, primary pulmonary hypertension in this case can cause circulatory problems, which will cause other organs and tissues of the human body to suffer.

Secondary form of the disease

Secondary type disorders occur as a result of many chronic diseases of the respiratory or cardiovascular system.

The most common causes of pulmonary hypertension are:

tuberculosis;
bronchial asthma;
vasculitis;
congenital or acquired heart defects;
heart failure;
pulmonary embolism;
metabolic disorders;
long stay in the mountains.

In addition, factors causing secondary hypertension may include:

taking certain medications in large quantities;
toxins;
cirrhosis;
obesity;
hyperthyroidism;
neoplasms;
heredity;
pregnancy.

The prognosis for survival depends on the form of pathology, stage and nature of the underlying cause. Thus, during the first year, about 15% of patients die from pulmonary hypertension.

In the second year of the disease, 32% of patients die, and the survival prognosis in the third year is 50%. Less than 35 percent of 100 survive the fourth year of the disease.

But these are general statistics. The individual prognosis depends on the course of the disease, namely:

rate of development of symptoms;
effectiveness of treatment;
forms of the disease.

The worst prognosis is observed in the primary form and moderate course.

Symptoms and stages of the disease

The main symptom of the pathology, as with most diseases of the respiratory system, is shortness of breath.

However, there are special differences:

shortness of breath is always present, even at rest;
does not stop when sitting.

Signs of pulmonary hypertension common to most patients:

weakness;
fatigue;
persistent cough (without sputum);
swelling of the lower extremities;
an enlarged liver provokes pain in this area;
chest pain can sometimes cause fainting;
expansion of the pulmonary artery leads to pinching of the laryngeal nerve, which can cause the voice to become hoarse.

Often the patient begins to lose weight regardless of his diet. Not only the physical, but also the psychological state worsens, and apathy appears.

Depending on how severe the symptoms are, pulmonary hypertension can be divided into 4 stages.

In the first stage there are no symptoms.
A decrease in physical activity indicates the beginning of the second stage of the disease. Shortness of breath, weakness and dizziness may occur. However, in a state of rest, all unpleasant sensations go away.
The third stage is characterized by the presence of all symptoms, which may persist even during rest.
At the fourth stage, the symptoms are pronounced, shortness of breath and weakness are constantly present.

Moderate pulmonary hypertension is considered the most dangerous. The weak severity of symptoms does not allow an accurate diagnosis to be established, which leads to incorrect treatment and the development of complications.

Diagnostic and treatment methods

Diagnosing the disease is quite difficult, especially if it is idiopathic hypertension, the treatment of which must be timely. A comprehensive diagnosis is needed, including such methods;

examination by a cardiologist and pulmonologist;
electrocardiogram;
echocardiography;
computed tomography;
Ultrasound of the heart;
general and biochemical blood test;
measurement of pressure in the artery of the lung.

Diagnosing hypertension is a complex process. But only based on its results can a doctor make a diagnosis and begin to treat the pathology. The basis of any therapy is blood pressure reduction. Treatment can be drug, non-drug, or surgical.

Treatment with folk remedies is not recommended. Some doctors may supplement therapy with traditional medicine, but this is rare. In any case, it is necessary to give preference to the advice of a specialist.

Drug treatment consists of taking the following drugs:

diuretics;
anticoagulants;
prostaglandins;
antibiotics (if necessary);
inhalation of nitric oxide.

This video talks about pulmonary hypertension:

If medications are ineffective, surgical treatment is prescribed. Typically, the following methods are used:

Atrial septostomy. An opening is created between the atria, which reduces the pressure in the artery of the lung.
If blood clots are present, thromboendarterectomy is performed.
Lung and/or heart transplantation is used in the most severe cases.

Non-drug method:

drinking at least 1.5 liters of fluid daily;
blood oxygen saturation;
bed rest.

Treatment with folk remedies is most often combined with drug therapy.

This video talks about treating pulmonary hypertension:

Hypertension is a serious disease, often fatal. The best prevention is regular examinations; this is the only way to identify pathology at the beginning of development.

Among the diseases of the cardiovascular system, there are many that can lead to serious complications and death of a person, sometimes in the early stages of development. A progressive, deadly pathology, pulmonary hypertension can occur in newborns, older children, and adults; it causes an increase in blood pressure in the pulmonary artery and ends in death. It is extremely important to begin treating pulmonary hypertension early, which will help improve the prognosis and prolong a person's life.

What is pulmonary hypertension

Pulmonary hypertension, or pulmonary hypertension (PH), is a group of pathologies in which there is a progressive increase in pulmonary vascular resistance, which provokes right ventricular failure and premature death. This disease is a severe type of cardiovascular disease that affects the pulmonary circulation, since sooner or later it leads to a strong drop in physical endurance and the development of heart failure. A pathology such as cor pulmonale has a close connection with pulmonary hypertension and occurs in conjunction with it.

The mechanism of development of the disease is as follows. The inner layer of the lung vessels (endothelium) grows, reduces the lumen of the arterioles, thereby disrupting blood flow. The resistance in the blood vessels increases, the right ventricle has to contract intensely in order to normally push blood into the lungs, for which it is completely unsuited. As a compensatory reaction of the body, the ventricular myocardium thickens, the right parts of the heart hypertrophy, but then there is a sharp drop in the force of heart contractions, and death occurs.

In pulmonary hypertension syndrome in humans, the average pressure in the pulmonary artery is 30 mmHg. and higher. Primary PH usually occurs in children from birth, and subsequently the resulting disease is recognized as secondary and is much more common. The prevalence of secondary PH is higher than the incidence of primary PH due to the presence of a large number of cases of chronic cardiovascular diseases and lower respiratory tract lesions.

Approximately 20 people per 1 million population per year become ill with this pathology, and in those suffering from chronic pulmonary diseases with hypoventilation of the lungs, it occurs in literally 50% of clinical cases.

Primary PH has a very poor prognosis for survival; in the secondary form, it is possible to increase life expectancy through timely treatment.

Classification of the disease

Pulmonary hypertension is primarily divided into primary and secondary. In turn, primary hypertension (Aerz disease) was divided into obliterating, arterial reticular, and thromboembolic forms. A more in-depth classification, including an understanding of the mechanisms of the disease, includes the following types of disease:

pulmonary arterial hypertension (more common than other types);
venous hypertension;
pulmonary capillary hemangiomatosis;
hypertension with damage to the left chambers of the heart, including systolic dysfunction of the right or left ventricle, damage to the valves of the left parts of the heart;
pulmonary hypertension due to diseases of the respiratory system (COPD, interstitial diseases, night breathing disorders, high-altitude pulmonary hypertension, lung malformations);
chronic thromboembolic (post-embolic) pulmonary hypertension; Check out the Thromboembolic Risk Score
pulmonary hypertension with an unclear mechanism of development.

The most common arterial hypertension of the lungs, which is divided into forms:

idiopathic;
hereditary (caused by a mutation of the type 2 receptor gene for bone morphogenesis protein, or triggered by a mutation of the activin-like kinase-1 gene, or other unknown mutations);
medicinal and toxic;
associated with connective tissue diseases, congenital heart disease (congenital heart disease), HIV and AIDS, chronic hemolytic anemia, schistosomiasis, etc.;
persistent hypertension of newborns.

According to the degree of functional impairment, the disease is divided into classes:

first - normal physical activity, good exercise tolerance, first degree heart failure (mild or borderline PH);
second - physical activity is reduced, the patient feels comfortable only without exertion, and with simple stress characteristic symptoms appear - shortness of breath, chest pain, etc. (moderate PH);
third - unpleasant symptoms occur at the smallest loads (high degree of PH, worsening prognosis);
fourth - intolerance to any stress, all symptoms of the disease are expressed even at rest, there are severe symptoms of congestion in the lungs, hypertensive crises, abdominal dropsy, etc. are added.

The classification according to the size of the blood discharge is as follows:

discharge of no more than 30% of the minute volume of the pulmonary circulation;
reset increases to 50%;
blood discharge more than 70%.

Differentiation of the disease by pressure is as follows:

first group - pressure in the pulmonary artery less than 30 mmHg;
second group - pressure 30-50 mmHg;
third group - pressure 50-70 mmHg;
fourth group - pressure above 70 mmHg.

Causes

Primary pulmonary hypertension, or Aerz's disease, is a very rare disease, its causes are not yet clear. It is assumed that other autoimmune diseases and disorders of the homeostasis system (especially high platelet activity) may somehow influence the development of primary PH. The pathology leads to primary damage to the vascular endothelium against the background of increased production of the vasoconstrictor substance endothelin, to fibrosis and necrosis of the walls of the pulmonary artery branches, which causes an increase in pressure and total pulmonary resistance.

As for other forms of primary hypertension, they can be caused by complicated heredity or gene mutation at the time of conception. The mechanism of disease development in this case is similar: imbalance in the exchange of nitrogen compounds - changes in vascular tone - inflammation - proliferation of the endothelium - reduction in the internal caliber of the arteries.

Secondary pulmonary hypertension allows us to track its etiology, which can be very diverse. There are two mechanisms for the development of the disease:

Functional - the normal functioning of certain parts of the body is disrupted, so all the changes characteristic of PH occur. Treatment is aimed at eliminating the pathological influence and can be quite successful.
Anatomical. PH is associated with the presence of a defect in the structure of the lungs or pulmonary circulation. Usually this type of disease does not respond to medications and can only be corrected by surgery, but not always.

Most often, PH is caused by pathologies of the heart and lungs. Heart diseases that can lead to the development of pulmonary hypertension include:

CHD (atrial septal defect, interventricular septal defect, patent ductus ductus, mitral valve stenosis, etc.);
severe hypertension;
cardiomyopathy;
coronary heart disease;
complications after surgery on the heart and coronary vessels;
chronic or acute thrombosis of pulmonary vessels;
atrial tumors.

No less often, the causes of PH come down to the presence of chronic diseases of the lower respiratory tract system, which lead to changes in the structure of lung tissue and alveolar hypoxia:

bronchiectasis - the formation of cavities in the lungs and their suppuration;
obstructive bronchitis with closure of part of the airways;
fibrosis of lung tissue and its replacement with connective tissue cells;
lung tumor compressing blood vessels.

The following risk factors may contribute to the development of the disease:

poisoning by poisons, toxins, chemicals;
taking drugs;
excessive consumption of anorectics, antidepressants;
pregnancy, especially multiple pregnancy;
living in a high mountain region;
HIV infection;
cirrhosis;
tumor diseases of the blood;
increased pressure in the portal vein (portal hypertension);
chest deformation;
severe obesity;
thyrotoxicosis;
some rare hereditary diseases.

Secondary hypertension can also be caused by other, less common causes, the mechanism of action of which on this area of the body is not always clear. These include myeloproliferative diseases, removal of the spleen, vasculitis, sarcoidosis, lymphangioleiomyomatosis, neurofibromatosis, Gaucher disease, glycogen storage pathologies, hemodialysis, etc.

Symptoms of manifestation

At the very beginning of its development, the disease is compensated and therefore occurs without symptoms. The normal pressure in the artery is 30 mm Hg. by systolic pressure, 15 mmHg. - according to diastolic. When this norm is exceeded by 1.5-2 times, the clinical picture of the disease becomes obvious. Sometimes secondary pulmonary hypertension is diagnosed only when the stage is already advanced and changes in the body are irreversible.

Symptoms of pulmonary hypertension are most often unspecific, and even a doctor can confuse them with other cardiac pathologies if a thorough examination is not carried out. However, the main symptom - shortness of breath - still has a number of characteristic features. Shortness of breath can also appear at rest, increases even with little physical activity, and does not stop in a sitting position, while shortness of breath with other heart diseases subsides under such conditions.

The most initial symptoms of PH during the development of uncompensated or partially compensated stages are as follows:

weight loss while taking into account normal nutrition;
weakness, loss of strength, depressed mood, general poor health;
hoarseness, hoarseness of voice;
frequent cough, coughing;
a feeling of bloating, fullness in the abdomen due to the onset of stagnation in the portal vein system;
nausea, dizziness;
fainting;
increased heart rate;
stronger pulsation of the neck veins than usual.

In the future, without adequate treatment, the patient's condition worsens greatly. There are also other clinical signs of PH - sputum with blood, hemoptysis, angina attacks with chest pain, fear of death. Different types of arrhythmias develop, most often atrial fibrillation. By this stage, the liver has already seriously increased in size, its capsule is stretched, so the person is bothered by pain in the right hypochondrium and a sharp increase in the abdomen. Due to developed heart failure, swelling of the legs and feet also appears.

In the terminal stage, suffocation increases, blood clots appear in the lungs, and some tissue dies due to lack of blood supply. Hypertensive crises and attacks of pulmonary edema appear. During a night attack, the patient may die from suffocation. The attack is accompanied by lack of air, severe coughing, bleeding from the lungs, bluish skin, and severe swelling of the veins in the neck. Uncontrolled excretion of feces and urine is possible. A hypertensive crisis can also be fatal, but most often patients with pulmonary hypertension die from acute heart failure or PE.

Complications and their prevention

The most common complication of the disease is atrial fibrillation. This disease in itself is dangerous due to the development of ventricular fibrillation, which, in essence, is clinical death from cardiac arrest. Also an inevitable and dangerous complication is pulmonary edema and hypertensive crisis, after which a person’s condition, as a rule, sharply worsens, and in the future he is assigned a disability. The consequences of advanced pulmonary hypertension are right ventricular failure, hypertrophy and dilatation of the right heart, thrombosis of the pulmonary arterioles. A fatal outcome is possible both from a combination of all these complications, which differ in their progressive course, and from pulmonary embolism - acute blockage of a vessel with a thrombus and stoppage of blood circulation through it.

Diagnosis of pathology

Since primary pulmonary hypertension is very rare, a detailed and very careful examination should be carried out to find the cause of PH, which is often secondary. For this purpose, as well as to assess the severity of the pathology, the following examination is carried out:

External examination, physical examination. The doctor pays attention to cyanosis of the skin, swelling of the legs and abdomen, deformation of the distal phalanges, changes in the shape of the nails like watch glasses, and existing shortness of breath. When auscultating the heart, an accent of the second tone is heard, its splitting in the area of the pulmonary artery. Upon percussion, expansion of the cardiac boundaries is noticeable.
ECG. Signs of overload of the right ventricle are revealed against the background of its expansion and thickening. There is often objective evidence of the presence of extrasystole, atrial fibrillation, and atrial fibrillation.
Chest X-ray. X-ray signs of PH are an increase in the size of the heart, an increase in the peripheral transparency of the pulmonary fields, an increase in the roots of the lungs, a shift of the borders of the heart to the right.
Echocardiography (ultrasound of the heart). Determines the size of the heart, hypertrophy and stretching of the right cavities of the heart, allows you to calculate the pressure in the pulmonary artery, and also detects heart defects and other pathologies.
Functional breathing tests, study of blood gas composition. They will help clarify the diagnosis and the degree of respiratory failure.
Scintigraphy, CT, MRI. Necessary for studying the condition of small pulmonary vessels and searching for blood clots.
Cardiac catheterization. Required for direct measurement of pulmonary artery pressure.

To assess the severity of the disease and the degree of impairment in other organs, the patient may be advised to do spirometry, ultrasound of the abdominal cavity, a general blood test, a urine test to test kidney function, etc.

Treatment methods Conservative treatment

The goal of conservative therapy is to eliminate etiological factors or correct them, reduce pressure in the pulmonary artery, and prevent complications, especially thrombus formation. Treatment is most often carried out in the hospital, after the exacerbation is relieved - at home. To do this, the patient is prescribed to take various medications:

Vasodilators (calcium channel blockers) - Nifedipine, Prazosin. They are especially effective in the early stages of pathology, when there are no obvious disorders in the arterioles yet.
Disaggregants - Aspirin, Cardiomagnyl. Necessary for blood thinning.
When the hemoglobin level in LH is above 170 g/l, as well as when the jugular veins are bulging, phlebotomy with a volume of 200-500 ml should be performed. More about cervical thrombus
Diuretics - Lasix, Furosemide. Used for the development of right ventricular failure.
Cardiac glycosides - Digoxin. Prescribed only if the patient has atrial fibrillation to reduce the heart rate.
Anticoagulant drugs - Warfarin, Heparin. Prescribed for those with a tendency to form blood clots.
Prostaglandins, prostaglandin analogues - Epoprostenol, Treprostinil. Reduce pressure in the pulmonary artery, slow down the pathological transformation of pulmonary vessels.
Endothelin receptor antagonists - Bosentan. They help reduce the rate of endothelin production and slow down the progression of PH.
Preparations for improving tissue metabolism - Riboxin, Potassium Orotate, vitamins.
Various drugs for the treatment of underlying pulmonary and cardiac diseases, and other pathologies that caused the development of pulmonary hypertension.

All patients with pulmonary hypertension are prescribed ozone therapy, oxygen therapy - oxygen inhalation. A positive effect is achieved after a course of oxygen treatment, so it is recommended up to several times a year.

Surgical methods of treatment

In some situations, surgery can help reduce the progression of the disease and increase life expectancy. For people with pulmonary hypertension, the following surgical treatment methods may be used:

Interatrial shunt or balloon atrial septostomy. By creating an artificial opening (open foramen ovale) between the atria, high pulmonary hypertension becomes lower, thereby improving the prognosis.
Lung transplant. To significantly reduce blood pressure, transplantation of only one lung is sufficient. However, within 5 years after such an operation, bronchiolitis obliterans occurs in half of the patients as a reaction to rejection of a new organ, and therefore long-term survival is in doubt.
Heart and lung transplantation. Possible only in the last stages of the disease, which is caused by congenital heart disease or cardiomyopathy. If surgery is performed at an early stage of pathology, life expectancy does not increase.

Folk remedies and nutrition

It is impossible to completely cure pulmonary hypertension without eliminating its causes even with traditional methods, not to mention treatment with folk remedies. But still, the advice of traditional healers will help reduce the symptoms of the disease and can participate in the treatment complex:

Brew a tablespoon of red rowan fruit with 250 ml of boiling water, leave for an hour. Drink half a glass 3 times a day in monthly courses.
Pour 250 ml of boiling water over a teaspoon of the herb and flowers of spring Adonis, let it brew, take 2 tablespoons of the infusion on an empty stomach three times a day for 21 days.
Drink 100 ml of fresh pumpkin juice daily, which will help get rid of arrhythmia due to pulmonary hypertension.

Nutrition for this pathology limits salt, animal fats, and the amount of fluid consumed. In general, the emphasis in the diet should be on plant foods, and animal products should be eaten in moderation, and only healthy, low-fat ones. There are some lifestyle recommendations for patients with pulmonary hypertension:

Vaccination against all possible infectious pathologies - influenza, rubella. This will help avoid exacerbation of existing autoimmune diseases, if the patient has them.
Dosed physical exercises. For any cardiac pathology, a person is prescribed special exercise therapy, and only in the last stages of PH should activities be limited or eliminated.
Prevention or termination of pregnancy. An increase in the load on the heart in women with pulmonary hypertension can lead to death, so pregnancy with this pathology is strictly not recommended.
Visit to a psychologist. Usually, people with PH develop depressive states and their neuropsychic balance is disturbed, therefore, if necessary, they need to visit a specialist to improve their emotional state.

Features of treatment in children and newborns

In childhood, secondary PH most often occurs due to hypoxia or pathology of the respiratory system. Treatment tactics should be based on the severity class of the disease, and, in general, it is similar to that in adults. Immediately after the diagnosis is completed, the child is hospitalized in a specialized center, in the children's department. Without fail, to maintain the normal state of the muscles, the child must perform dosed physical activity every day that does not cause any complaints. It is extremely important to prevent infectious diseases and hypothermia.

Cardiac glycosides are given to children only in short courses; diuretics are selected taking into account maintaining the balance of electrolytes. The use of anticoagulants in children is a controversial issue, since their complete safety at an early age has not yet been proven. The only drug available for use is Warfarin, which is taken in tablet form if necessary. Vasodilators that lower pressure in the pulmonary artery are prescribed without fail, which are initially introduced into the course of therapy in a minimal dose, and it is then adjusted.

If there is no effect from treatment with calcium channel blockers - the simplest type of vasodilators - other drugs with the same effect are prescribed - prostaglandins, phosphodiesterase-5 inhibitors, endothelin receptor antagonists (they are a priority in childhood), etc. In pediatrics, the most effective specific drug for pulmonary hypertension is Bosentan, which is used from the age of 2-3 years. Additionally, the child is prescribed massage, exercise therapy, and sanatorium-resort treatment. In newborns, only primary pulmonary hypertension occurs, or pathology associated with severe congenital heart disease, which is treated in a similar way, but has an unfavorable prognosis.

Prognosis and life expectancy

The prognosis depends on the cause of the disease, as well as on the level of pressure in the artery. If the response to therapy is positive, the prognosis improves. The most unfavorable situation occurs for those patients who have a consistently high level of pressure in the pulmonary artery. With a decompensated degree of the disease, people usually live no more than 5 years. The prognosis for primary pulmonary hypertension is extremely unfavorable - survival after a year is 68%, after 5 years - only 30%.

Preventive measures

Basic measures to prevent the disease:

quitting smoking;
regular physical activity, but without excess;
proper nutrition, avoiding excess salt;
timely treatment of the underlying pulmonary and cardiac pathology, which is provoked by PH;
early start of clinical monitoring of persons with COPD and other lung diseases;
eliminating stress.

Pulmonary hypertension in COPD. The development of pulmonary hypertension is considered one of the most important prognosis factors for patients with COPD. Numerous studies have demonstrated the prognostic significance of parameters such as RV dysfunction, mean pulmonary artery pressure, and pulmonary vascular resistance (PVR). The results of Burrows' 7-year follow-up of 50 patients with COPD showed that pulmonary vascular resistance is one of the most important predictors of patient survival. None of the patients with a value of this parameter above 550 dynkhschem5 lived more than 3 years.

According to data obtained from several long-term studies, mortality in patients with COPD is closely related to the degree of pulmonary hypertension. At a level of average pressure in the pulmonary artery of 20-30 mm Hg. The 5-year survival rate of patients is 70-90%, with values of this indicator being 30-50 mmHg. - 30%, and with severe pulmonary hypertension (average pressure in the pulmonary artery more than 50 mm Hg), the 5-year survival rate of patients is almost equal to a bullet. Similar data were obtained in a recently published study by the Strasbourg group: the authors compared the survival of patients with COPD at a pulmonary artery pressure of less than 20 mm Hg, 20-40 mm Hg. and more than 40 mm p I I year. The highest mortality was observed in patients with severe pulmonary hypertension (Fig. 1).

Rice. 1. Survival of patients with COPD depending on the severity of pulmonary hypertension

The level of pulmonary artery pressure is considered not only a prognostic factor, but also a predictor of hospitalization in patients with COPD. In the Kessier study, which included 64 patients with COPD, the increase in pulmonary artery pressure at rest was more than 18 mmHg. turned out to be the strongest independent risk factor for hospitalization of patients (Fig. 2). This relationship indicates the possibility of identifying a group of the most vulnerable patients in need of aggressive therapy. Thus, active correction of pulmonary hypertension in patients with COPD can significantly improve their functional status and reduce the frequency of hospitalization.

Rice. 2. Branch of the pulmonary artery (arteriole) in a patient with COPD: intimal hyperplasia, moderate medial hypertrophy. Hematoxylin and eosin staining. Uv. x 200.

Pulmonary hypertension in idiopathic pulmonary fibrosis. Pulmonary hypertension is considered an unfavorable prognostic factor in patients with idiopathic pulmonary fibrosis. According to Lettieri, the mortality rate during the first year among patients with idiopathic pulmonary fibrosis with pulmonary hypertension was 28%, and among patients with this pathology, but without pulmonary hypertension, it was 5.5%. According to data obtained at the Mauo Clinic, the median survival rate of patients with systolic pressure in the pulmonary artery more than 50 mm Hg. (according to the results of EchoCG)) was 8.5 months, and in patients with systolic pressure in the pulmonary artery less than 50 mm Hg. - 4 years.

Avdeev S.N.

Secondary pulmonary hypertension

A pathological condition characterized by increased pressure in the pulmonary artery is called pulmonary hypertension in medicine. The disease ranks third in frequency worldwide among vascular diseases characteristic of older people.

Causes of pulmonary hypertension

Pulmonary hypertension can be either a congenital anomaly, that is, primary, or an acquired one, which is called secondary.

The following factors may cause increased pressure in the arteries of the lungs:

heart failure;
vasculitis;
heart defects of various origins;
chronic lung diseases, including tuberculosis, bronchial asthma, etc.;
PE or other pulmonary vascular lesions;
metabolic disorders;
location in high mountain regions.

In cases where the exact causes of hypertension cannot be determined, the doctor makes a diagnosis of primary hypertension. A painful condition of unknown origin, primary pulmonary hypertension can be triggered by various contraceptive methods or result from an autoimmune disease.

Secondary pulmonary disease can be caused by pathologies of the heart muscle, lungs or blood vessels.

Classification of the disease

Depending on the severity of the disease state, doctors distinguish 4 classes of patients:

The first stage, not accompanied by loss of physical activity. A patient with pulmonary insufficiency can withstand normal activities without weakness, dizziness, chest pain, or shortness of breath.
At the second stage disease, the patient's physical activity is limited. At rest there are no complaints, but habitual exercise causes severe shortness of breath, dizziness and severe weakness.
Third stage of hypertension causes the above symptoms with the slightest physical activity of a person suffering from this disease.
Stage 4 pulmonary hypertension is marked by pronounced signs of weakness, shortness of breath and pain, even when the person is in a state of absolute rest.

Symptoms of pulmonary failure

The main symptom of the disease is shortness of breath, which has several specific features that make it possible to distinguish it from the symptoms of other diseases:

schematic structure of the blood vessels of the lungs

observed in a state of rest;
its intensity increases with minimal physical activity;
in a sitting position, shortness of breath does not stop, unlike shortness of breath of cardiac origin.

Other signs of pulmonary hypertension are also typical for most patients:

weakness and increased fatigue;
persistent dry cough;
swelling of the legs;
pain in the liver area caused by its enlargement;
pain in the sternum due to the fact that the pulmonary artery dilates;
in some cases, a hoarse voice is observed. This is caused by the fact that when the artery expands, it pinches the laryngeal nerve.

Thus, pulmonary hypertension, the symptoms of which are often not specific, does not always make it possible to establish the correct diagnosis without a whole range of examinations.

Diagnosis of the disease

As a rule, patients come to doctors with complaints of severe shortness of breath, which interferes with their daily life. Since primary pulmonary hypertension does not have specific symptoms that allow a confident diagnosis at the first visit to the doctor, diagnosis should be carried out with the participation of a cardiologist and pulmonologist.

The set of procedures involved in the diagnosis process includes the following methods:

examination by a doctor and recording of anamnesis. Often the disease has hereditary causes, so it is extremely important to collect information about family ailments;
clarification of the patient’s current lifestyle. Smoking, refusal of physical activity, taking various medications - all this is important when determining the causes of shortness of breath;
general inspection. On it, the doctor has the opportunity to identify the physical condition of the veins in the neck, skin color (blue in the case of hypertension), enlarged liver, swelling in the legs, thickening of the fingers;
electrocardiogram. The procedure allows you to identify changes in the right side of the heart;
echocardiography helps determine the speed of blood passage and the general condition of blood vessels;
will show, using a layer-by-layer image, an enlargement of the pulmonary artery, as well as possible concomitant ailments of the lungs and heart;
X-ray of the lungs will allow you to observe the condition of the artery, its expansion and narrowing;
the catheterization method is used to reliably measure the pressure inside the pulmonary artery. Doctors consider this procedure not only the most informative for obtaining pressure values, but also associated with minimal risks of complications;
the “6-minute walk” test helps determine the patient’s physical response to exercise and establish the class of hypertension;
blood test: biochemical and general;
Angiopulmonography allows, by introducing a special contrast agent into the vessels, to obtain a complete picture of the vessels in the area of the pulmonary artery. The method must be used with extreme caution, since its use can provoke a hypertensive crisis in the patient.

Thus, pulmonary hypertension should be diagnosed only after a thorough comprehensive examination of the patient's vascular condition to avoid misdiagnosis.

Reason to see a doctor

The patient should consult a doctor if he feels the following signs of illness:

the occurrence or worsening of shortness of breath when performing normal daily activities;
the appearance of pain of unknown origin in the chest area;
if the patient has an inexplicable and persistent feeling of fatigue;
the appearance or increase in the degree of swelling.

Treatment of pulmonary failure

In most cases, primary pulmonary hypertension is treatable. The main guidelines when choosing a treatment method are:

identifying and eliminating the cause of the patient’s condition;
decreased pressure in the artery of the lung;
preventing the formation of blood clots in the patient’s vascular system.

When prescribing treatment, the doctor may prescribe the following medications:

medications that have a relaxing effect on the muscle layer of blood vessels. This group of drugs is very effective in the initial stages of the disease. Pulmonary hypertension, treatment of which was started before vascular changes become pronounced and irreversible, has a very good chance of completely relieving the patient of symptoms;
medications designed to reduce blood viscosity. If the blood thickening is very severe, the doctor may decide to bleed. The hemoglobin level in such patients should not exceed 170 g/l;
with severe shortness of breath and hypoxia, oxygen inhalation is indicated as a means of relieving unpleasant physiological symptoms;
the doctor may recommend reducing salt intake in food and reducing fluid intake to one and a half liters of clean water per day;
a strict ban on intense physical activity. Only such activity is allowed in which the patient does not feel discomfort or painful manifestations;
if pulmonary hypertension is accompanied by a complication in the form of insufficiency of the right ventricle of the heart, the doctor prescribes regular use of diuretic medications;
in the most advanced cases of the disease, they resort to a heart and lung transplant procedure. The technique has not yet been sufficiently developed in practical conditions, but the statistics of such transplantations indicate their effectiveness.

Possible complications

Among the negative consequences of the disease, the main ones can be identified:

worsening heart failure. The right parts of the heart may no longer cope with their current load, which further worsens the patient’s situation;
a condition called PE - thrombosis of an artery in the lung, when a blood clot blocks a vessel. This disease is not only dangerous, but directly threatens the patient’s life;
associated with pulmonary edema.

As a rule, the disease significantly reduces the patient's standard of living and in most cases leads to premature death.

In this case, pulmonary hypertension causes chronic or acute forms of cardiac and pulmonary failure, which are life-threatening for the patient.

Prevention

In order to minimize the risk of this disease, the following measures must be taken:

adhere to the principles of a healthy lifestyle. In particular, it is necessary to categorically stop smoking and do physical exercise daily;
It is necessary to promptly identify and treat the underlying diseases leading to hypertension. This is possible with regular preventive visits to the doctor;
with established diseases of the bronchi and lungs that are chronic in nature, you need to carefully monitor the course of the disease. Clinical observation will help avoid complications of the disease and facilitate its course;
Diagnosed pulmonary hypertension is not a ban on any physical activity. On the contrary, such patients are advised to exercise moderately in the fresh air. Activity should be regular, but in no case more intense;
all situations that entail a stressful state must be excluded. Conflicts at work, at home or in transport can cause an exacerbation of the disease.

Thus, the sooner the patient consults a doctor and the more carefully he follows his instructions, the greater the chance of stopping the course of the disease and not transferring it to a more severe stage that is less treatable.