Last updated on January 11, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on January 11, 2022
Pulmonary hypertension is a condition related to high blood pressure in pulmonary arteries. It affects the heart’s right side and arteries in the lungs. In the case of pulmonary arterial hypertension, the blood vessels inside the lungs narrow down. The damage in the blood vessels slows down blood flow inside the lungs.
As a result, blood pressure increases in the arteries. Due to the obstruction in blood flow, the heart needs to work faster to pump blood. Eventually, the heart becomes weak and fails as a result of putting in the extra effort.
Pulmonary hypertension treatment is usually administered at the onset of symptoms to avoid further damage to the heart and lungs. While pulmonary hypertension treatment is necessary, not all cases of pulmonary hypertension can be treated. However, doctors recommend certain steps to prevent the disease from occurring.
This article will provide you with detailed information about pulmonary hypertension and a few ways to manage it.
Pulmonary hypertension is a condition related to high blood pressure in pulmonary arteries. It affects the heart’s right side and arteries in the lungs. In the case of pulmonary arterial hypertension, the blood vessels inside the lungs narrow down. The damage in the blood vessels slows down blood flow inside the lungs.
As a result, blood pressure increases in the arteries. Due to the obstruction in blood flow, the heart needs to work faster to pump blood. Eventually, the heart becomes weak and fails as a result of putting in the extra effort.
Pulmonary hypertension treatment is usually administered at the onset of symptoms to avoid further damage to the heart and lungs. While pulmonary hypertension treatment is necessary, not all cases of pulmonary hypertension can be treated. However, doctors recommend certain steps to prevent the disease from occurring.
This article will provide you with detailed information about pulmonary hypertension and a few ways to manage it.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
Pulmonary hypertension is a condition that occurs when the blood vessels from the heart to the lungs become narrowed, thus restricting blood flow through these vessels. Due to this, the blood pressure in these blood vessels, called pulmonary arteries increases beyond normal levels. This unusually high pressure puts the right ventricle (lower right chamber) of the heart under strain, as a result of which it expands. Since the right ventricle is enlarged, it becomes weak and struggles to pump sufficient blood to the lungs, resulting in complications like congestive heart failure. This is why treatment for pulmonary hypertension is necessary to prevent oxygen levels from dipping to dangerous levels in the body.
Pulmonary hypertension can fall into 5 main groups:
We will touch upon these types in more detail in the 3rd section of this article.
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The symptoms of pulmonary hypertension often do not show until it’s too late. This often causes delays in pulmonary hypertension treatment. Given below are some of the symptoms that should not be ignored.
Pulmonary hypertension often causes shortness of breath. People experience shortness of breath while doing regular activities. Gradually, it increases and is often experienced even while resting. Dyspnea creates a tight feeling within the chest, making it difficult for an individual to breathe.
Fatigue as a symptom is often ignored, which delays severe pulmonary hypertension treatment. The different types of pulmonary hypertension cause a temporary drop in the amount of blood flowing to the brain. As a result, a person can faint, which is called syncope in medical terms.
Primary pulmonary hypertension is progressive, which means the symptoms get worse with time. Chest pain or sudden pressure on the chest is experienced as the problem begins to become serious in a person.
A bluish tint in your skin and lips indicates severe pulmonary hypertension. This tells you simply that your body is having trouble getting oxygenated. When your hands and feet also start exhibiting a bluish tint, it is known as peripheral cyanosis.
Pulmonary arterial hypertension symptoms involve an increase of fluid retention in your body. The swelling of arms and legs occurs as the fluid gets trapped within the tissues and the issue is known as oedema in medical terms. People with mild pulmonary hypertension may not experience it. But as the strain on the heart increases, this symptom begins to show up. Treatment of pulmonary hypertension involves a restriction in the amount of salt intake as salt worsens oedema.
Some types of pulmonary hypertension cause a racing pulse. It occurs as the heart is required to put in the effort to pump blood. People with mild pulmonary hypertension do not have to worry about this symptom.
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Now that we have touched upon the symptoms of pulmonary hypertension, let’s look at how each group of pulmonary hypertension is caused.
The causes of pulmonary hypertension vary depending on the type of pulmonary hypertension. This condition can be divided into 4 groups.
Some of the causes of this type of pulmonary arterial hypertension are:
One of the main PAH causes occurs due to the genetic predisposition of the person.
Some prescription drugs such as appetite suppressants can be one of the leading PAH causes. The abuse of illegal drugs like meth also increases the risk of PAH.
Congenital heart diseases are associated with left-to-right shunt defects that ultimately lead to PAH.
People with connective tissue disorders such as scleroderma and lupus are more likely to develop PAH.
PAH can occur in patients with chronic liver diseases for many reasons, including pulmonary arterial bed obstruction.
People with HIV infections are at an increased risk of developing PAH. Bacterial pneumonia is common in patients who have contracted PAH through HIV infections.
when the exact cause is not known.
The causes of this type of pulmonary hypertension include:
Left-sided valve diseases affect the mitral valve (the valve located between the left atrium and the left ventricle), which in turn, can lead to pulmonary hypertension.
Pulmonary hypertension from left heart diseases often results from impairment in the systolic pressure (measures the pressure in your arteries when your heart contracts) and the diastolic pressure (measures the pressure in your arteries when your heart relaxes between beats) of the left ventricle.
When the heart does not get filled with adequate blood, it results in diastolic dysfunction which is one of the causes of pulmonary hypertension.
It narrows down or destroys the blood vessels in the lungs. Increased pulmonary pressure makes the heart work faster than usual.
If you are a patient with pulmonary hypertension that is caused by lung diseases, the symptoms will differ from those of PAH. Pulmonary hypertension that is caused by chronic lung diseases may have symptoms such as an increased need for oxygen. Diagnosing is done through a physiological assessment as well as imaging. This is to check on the blood flow as well as to detect if lung disease is the cause of any rise in pulmonary artery pressure.
Some of the causes of this type of pulmonary hypertension are:
The tissues in the lungs get scarred and thicken with progress in time.
When people face breathing issues while sleeping, it increases pressure in the blood vessels of the lungs.
It can lead to permanent remodelling of the pulmonary vascular structure as a result of increased resistance in the pulmonary vascular tissues. It can mess up with pulmonary artery systolic pressure.
One of the leading causes of pulmonary hypertension is the deprivation of adequate oxygen supply in a particular region of the body.
It makes the lungs stiff due to the fact that oxygen cannot be obtained efficiently in the bloodstream.
Pulmonary Hypertension caused by blood clots in the lungs is known as Chronic Thromboembolic Pulmonary Hypertension (CTEPH). In this type of pulmonary hypertension, scarring of the tissues in the pulmonary arteries may occur because of blood clotting. There are a couple of reasons this may happen. One reason could be that if a person is bedridden for long periods of time because of an illness. Patients who have also undergone any replacement surgery may also be at a higher risk of CTEPH. If you do notice any symptoms and you fall into the above-mentioned categories or if you know someone who is experiencing them, be sure to consult with a doctor immediately.
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) may be caused due to:
Due to pulmonary embolism, one pulmonary artery gets blocked and affects pulmonary artery systolic pressure. The blood clots usually travel to the lungs from deep veins, particularly in the legs.
Clotting disorders such as Antiphospholipid Antibody Syndrome (APLA) and Systemic Lupus Erythematosus (SLE) have been shown to cause thromboembolic pulmonary hypertension.
Antiphospholipid Antibody Syndrome (APLA) is a blood clotting condition where antibodies are mistakenly created by the immune system making your blood clot more than usual.
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune condition that can also cause deep vein blood clots in the veins and arteries.
The causes of this type of pulmonary hypertension may include any of the following medical conditions:
Overproduction of blood cells due to these blood disorders can be one of the leading signs of pulmonary hypertension.
Evidence has been found to prove that chronic inflammation can cause pulmonary hypertension.
Metabolic transformations in the body are known to influence pulmonary hypertension. Both hypothyroidism and hyperthyroidism can be associated with pulmonary hypertension.
These tumours are found to be one of the causes of PAH. The signs of pulmonary hypertension due to tumours can be different respiratory diseases.
When blood carrying oxygen combines with blood poor in oxygen, it returns to the lungs without going to the other parts of the body. This increases pulmonary pressure and calls for treatment for pulmonary hypertension.
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The different methods for pulmonary hypertension diagnosis are mentioned below:
A comprehensive metabolic panel blood test, coagulation profile, antibody panel test can be advised by your doctor to figure out the reason for pulmonary hypertension. It includes basic metabolic panel tests along with liver function tests. Sometimes thyroid tests are also done.
A chest X-ray helps in determining the conditions of the lungs, chest and heart. A chest X-ray can be used to determine whether the heart or pulmonary arteries have enlarged. But it is not reliable to detect PAH in patients. Chest X-rays are used as they are easily accessible.
It helps in analyzing the electrical functions of the heart. These electrical functions are associated with the proper beating of the heart. If the heart beats in proper rhythm without any error, it is a good indication. But pulmonary hypertension treatment is considered even with the slightest changes in the electrical impulses of the heart.
Another method for pulmonary hypertension diagnosis is using sound waves to get images of the heart. It helps a doctor to detect if any part of the heart has become enlarged. If an echocardiogram is done, the doctor will place a device on the chest. In cases of transesophageal echocardiogram, an imaging device is inserted in the oesophagus.
Sometimes, echocardiograms can be inconclusive when it comes to detecting pulmonary hypertension. In such cases, right heart catheterization is used to diagnose pulmonary hypertension. The test helps to measure the blood pressure inside arteries. A small and flexible tube is inserted through a neck or groyne blood vessel. The tube is then threaded to the heart to ensure the amount of pressure can be detected.
It is a test to find out how much air can be held by your lungs. It also helps in checking how much air is flowing in and out of the lungs. The test is done quite a few times to find out how the lungs are functioning and for measuring pulmonary artery pressure.
This test involves the injection of a tracer inside an arm vein. The tracer is used to determine the airflow and blood flow to the lungs. A V/Q scan is beneficial in analyzing if there are blood clots inside the lungs. Since blood clots are a common symptom of pulmonary hypertension, this method can be quite useful.
Pulmonary angiography helps in identifying pulmonary hypertension due to blood clots. Later on, pulmonary hypertension treatment such as thromboendarterectomy (surgery to remove blood clots and scar tissue from the arteries in your lungs) is opted for. Pulmonary angiography is an excellent way of determining the stages of pulmonary hypertension.
A chest CT scan provides cross-sectional images of your chest. As a result, your doctor can determine blockage, damage or artery narrowing. It can help in measuring pulmonary artery pressure.
This is a test that can be used to measure brain activity, blood pressure, heart rate, oxygen level and a few other factors during sleep. It is beneficial in identifying sleeping disorders like obstructive sleep apnea. Since obstructive sleep apnea is a common symptom of pulmonary hypertension, this method is quite beneficial and reliable.
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Management of pulmonary hypertension depends on the underlying cause. There are few surgeries and medications that can help in the effective management of pulmonary hypertension, which in turn can help reduce the chances of developing complications. However, note that surgery is only done in the advanced stages of pulmonary hypertension. It is important to consult your doctor before opting for any of the surgeries or medicines given below.
This operation can help in removing blood clots from the lungs. It is useful for people with chronic pulmonary hypertension resulting from blood clots in the lung arteries. It is a complex operation involving the opening of the pulmonary arteries.
It is a comparatively new procedure in medical science for treatment for pulmonary hypertension. In this process, a tiny balloon is inserted into the arteries. The balloon is inflated for a few seconds so that the blockages can be pushed aside. This helps in restoring blood flow to the lungs. Balloon pulmonary angioplasty is opted for if pulmonary thromboendarterectomy does not seem suitable. The method can help lower blood pressure within the lung arteries, improve your ability to exercise and relieve breathing difficulties.
Atrial septostomy involves making a small hole in the left and right atria. The hole is made by inserting a thin and flexible tube in the heart. The tube, which is known as a cardiac catheter, helps to reduce pressure on the right side of the heart. This enables the heart to pump blood more efficiently. Therefore, blood flow to the lungs is improved.
A lung transplant or heart transplant may be required if the case of organ damage due to pulmonary hypertension is severe. However, a transplant is required quite rarely. Most of the time, medications can help in curing the problem.
The medicines for pulmonary hypertension are prescribed according to the underlying cause and stages of pulmonary hypertension. However, before taking any medication, it is advised to consult a doctor who will be able to guide you through the right medications and therapies for pulmonary hypertension according to the intensity of your symptoms.
If your doctor wants to manage your blood pressure they may use blood vessel dilators (vasodilators), calcium channel blockers or diuretics can be prescribed to lower the blood pressure of your pulmonary arteries as well as of the body. Vasodilators help in opening narrowed blood vessels, leading to normal pulmonary artery pressure.
Other medications may be prescribed to help maintain pulmonary hypertension. For example:
To minimise the risk of clots – blood thinners or anticoagulants may be prescribed.
To help with breathing, medicines (oral or inhalation) can be prescribed to broaden the airways and facilitate breathing.
Other medications that will help improve heart function can be prescribed as needed.
For patients facing difficulty in sleeping, symptomatic treatment and therapies usually help like oxygen therapy. People living at high altitudes or suffering from sleep apnea are recommended by doctors to breathe oxygen at the prescribed concentration and flow rate.
Be sure to consult with your doctor about the right treatment that will suit you for your condition.
Acupuncture improves blood circulation in the body. Therefore, people with pulmonary hypertension can opt for acupuncture and improve the flow of blood in and out of the lungs.
Put some castor oil on a clean and soft cloth. Place the cloth on your chest and use a plastic bag to cover it. You can also put something hot on the plastic bag and keep it on your chest for an hour. Do it for three days consecutively, take a break of a couple of days and do it again.
Contrast hydrotherapy revolves around putting something hot and cold on your chest alternatively. Place something hot for three minutes followed by something cold and keep it for a minute. Repeating the same thing thrice will complete one set. You may perform two to three sets every day.
Put three to six drops of essential oils in a vaporizer, atomizer, humidifier or warm bath. It will help in improving breathing as a result of better circulation. Eucalyptus, thyme, rosemary or lavender can be a few good options of essential oils.
These are some remedies that are often opted by people. We do not have any strong research-backed data to support the effectiveness of the above-mentioned remedies in managing pulmonary hypertension. It is advised to consult a qualified doctor (a cardiologist and an expert in pulmonary medicine) for the treatment of this condition.
A pulmonary hypertension diagnosis can be daunting. However, there are many diagnosed patients who have been able to manage pulmonary hypertension and lead a healthy lifestyle. Here are some ways you can manage pulmonary hypertension with ease:
You should take your medicines on time and go to the doctor for regular check-ups.
Including herbs in your diet can help you better manage pulmonary hypertension. Leafy green vegetables will provide you with iron and vitamin K.
People experiencing fatigue due to pulmonary hypertension are advised by doctors to get enough rest.
Cutting back on your salt and sodium intake is a good way to manage pulmonary hypertension.
Pulmonary hypertension treatment involves limiting the fluid intake of a person, especially in the case of PAH. This helps in avoiding fluid buildup inside the body.
Some birth control pills may increase the risk of blood clots inside the body. Therefore, it is recommended to avoid them to prevent the risk of pulmonary hypertension.
Maintaining a healthy weight is necessary to manage pulmonary hypertension. You may ask your doctor to prepare a diet chart for you to manage your weight better.
Stimulants such as caffeine and alcohol should be avoided to regulate blood pressure.
There may be complications that could arise from Pulmonary hypertension if left untreated or undiagnosed. They include:
Heart failure and cor pulmonale – Cor pulmonale is the enlargement of the right ventricle. When the right ventricle expands (or enlarges), it would result in the heart pumping harder than it’s supposed to. As the heart pumps blood through all the narrow arteries, the heart walls begin to thicken and cause the right ventricle to increase its capacity of the blood. This causes a strain on the heart which will eventually cause the right ventricle to fail.
Blood clots – This is another complication that could arise from pulmonary hypertension and put you at risk of blood clotting in the arteries.
Arrhythmia (Irregular Heart Beats) – With pulmonary hypertension comes the risk of arrhythmia (irregular heartbeats). This in turn may cause heart palpitations, dizziness and/or even fainting.
Bleeding in the lungs – Pulmonary hypertension may also cause bleeding in the lungs. When this happens you may experience coughing up blood. This risk is life-threatening and must be treated immediately.
Complications in pregnancy – Pulmonary hypertension may also cause complications during pregnancy and can also be life-threatening to the growing baby.
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Can pulmonary hypertension be prevented? In most cases, if you find yourself at risk of developing the condition, is it advised to relook at your diet and lifestyle and make a few changes that can help reduce your chances of developing the condition in the future. They include:
A healthy diet is essential to manage pulmonary hypertension. Opt for a diet filled with vegetables, fruits, lean meat, wholegrain and low-fat dairy. You must reduce your salt intake to avoid fluid retention. The consumption of complex carbohydrates and legumes can also be beneficial.
Being overweight often puts extra pressure on your body. Weight around the waist is associated with an increased risk of health conditions like heart disease and type 2 diabetes.
Regular exercise helps in staying physically fit. It can reduce blood pressure and reduce the risk of heart diseases. Exercising daily for 30 minutes is good for health. Even if you cannot exercise daily, some moderate physical activity is recommended.
You should check your blood pressure from time to time and see if it’s on the higher side. Blood tests should be done at frequent intervals to determine the cholesterol levels in the body. High blood pressure and high cholesterol can prove detrimental to your health.
Managing stress is important to alleviate the issue of pulmonary hypertension. Meditation is a good way to manage your stress levels.
Knowing if you’re at risk of developing pulmonary hypertension can go a long way in coming up with a prevention plan. You may be at risk of the condition if:
You have a member of your family who has or has had pulmonary hypertension in the past.
You are overweight or obese.
You are currently diagnosed with a blood-clotting disorder or have a family history of clotting disorders especially related to the lungs.
You are exposed to asbestos for long periods of time.
You have been diagnosed with congenital heart disease.
You are residing at a higher altitude.
If you have had surgery especially a joint replacement surgery or bedridden for long.
The consumption of certain medications and substances can also increase your risk of the condition. For example,
Certain drugs prescribed for weight-loss
Cocaine and other illegal drugs
Medicines to treat some mood disorders
Estrogen containing birth control pills can heighten your risk of pulmonary hypertension.
It is also important to go for regular health check-ups. Notify your doctors if you notice any symptoms that may be indicative of pulmonary hypertension. Doctors will be able to check your pulse rate and ask you to get tests done to further diagnose the problem.
Pulmonary hypertension is a rare condition but it requires timely diagnosis and effective treatment to avoid complications. Consult a doctor as soon as you begin experiencing symptoms. Even though there are medications for pulmonary hypertension, certain lifestyle changes should also be made. Eliminate unhealthy eating habits and focus on a more balanced diet rich in herbs, iron and vitamin K. Regular exercise and stress management are two other important factors that can help in the management of pulmonary hypertension. Understand the possible risk factors and work with your doctor to eliminate any further complications. Smoking should be off the charts while alcohol consumption should only be done in moderation. The lifestyle changes you make can go a long way in preventing pulmonary hypertension from becoming worse.
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It is difficult to predict the lifespan of a person with pulmonary hypertension, as every individual has their own underlying conditions. It also depends on which stage of pulmonary hypertension they are at. Your treating doctor can be the best person to help you with this query.
Yes, pulmonary hypertension is life-threatening and can cause permanent damage to the heart or lungs if left untreated.
No, pulmonary hypertension cannot be reversed but can be managed to improve symptoms and increase life expectancy.
No, garlic cannot cure pulmonary hypertension. However, its anti-inflammatory properties can help to reduce related symptoms and risk factors.
Yes, with pulmonary hypertension treatment, it is possible to live a normal life. Patients must follow their treatment plan and lifestyle modifications carefully to manage symptoms and prevent complications.
It is possible to sleep with pulmonary hypertension but it may be more difficult, depending on the severity of symptoms. Pulmonary hypertension treatment can help manage many of these issues so patients are able to get a good night’s rest.
Yes, sometimes asthma inhalers can help manage the respiratory symptoms due to pulmonary hypertension by opening the airways and increasing oxygen flow to the lungs. These inhalers can provide symptomatic relief and will not cure pulmonary hypertension. This should be used only when advised by a doctor.
Eating does not typically make pulmonary hypertension worse, although patients should consult with their doctor to determine what diet changes are necessary and safe for them.
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