Hypertension Pulmonary

Pulmonary hypertension is a disease that is rarely found but because of progressive increase in pulmonary vascular resistance leading to decreased right ventricular function because of increased right ventricular afterload.Primary pulmonary hypertension is a rare disease of unknown etiology, whereas secondary pulmonary hypertension is a complication of many pulmonary diseases, cardiac and extrathoracic conditions. Chronic obstructive pulmonary disease, left ventricular dysfunction and disorders associated with hypoxemia frequently result in pulmonary hypertension

Diagnosis of pulmonary hypertension

To diagnose pulmonary hypertension, the doctor may perform one or more tests to evaluate the work of the heart and lung patients. This includes X-ray in the chest area to show an enlarged and abnormal vessels of the lungs, echocardiograms showing the visualization of the heart, a large measure of heart size, function and blood flow, and holding an indirect measurement of pressure in the vessels of the lungs.

With Radiology

Typical lung parenchyma in pulmonary hypertension net. Photos of the piston can help diagnose or help find other underlying disease pulmonary hypertension. Typical chest X-ray picture of pulmonary hypertension was found in hilar shadow, shadow the pulmonary artery and the lateral chest X-ray right ventricular enlargement.

Treatment of pulmonary hypertension

Treatment of pulmonary hypertension aims to optimize the left heart function by using drugs such as diuretics, beta-blockers and ACE inhibitors or by repairing the mitral heart valve or the aortic valve (the main blood vessel). In the treatment of pulmonary hypertension with lifestyle changes, diuretics, anticoagulants, and oxygen therapy is a therapy commonly done, but based on the study of the therapy has not been declared beneficial in overcoming the disease tersebut.Some possible treatment for pulmonary hypertension are listed in Table.Treatment of primary pulmonary hypertension is a complex, controversial and potentially dangerous.Patients benefit from referral to centers specializing in the management of common problems ini.Calcium channel blockers can reduce pulmonary vasoconstriction and prolong life in about 20 percent of patients with primary pulmonary hypertension. Unfortunately, there is no way to predict which patients will respond to vasodilators administered orally, and these drugs usually have a significant effect. Consequently, it is helpful to evaluate pulmonary vasoreactivity during catheterization, before long-term therapy is chosen. The most suitable drugs for testing acute response to a strong, short-acting and titratable. In patients who show evidence of acute hemodynamic response, long-term treatment with calcium channel blockers, administered orally in high doses, can produce a sustained hemodynamic response and improve survival. Epoprostenol (Flolan), or prostacyclin, is one of the most important advances in the treatment of primary pulmonary hypertension. This Powerful short-acting vasodilator and inhibitor of platelet aggregation produced by the endothelium vaskularDalam one study, continuous intravenous infusion of epoprostenol exercise capacity, quality of life, hemodynamics and long-term survival in patients with class III or IV function.Although continuous infusion delivery system is complex, most patients can learn how to prepare and inject. Anticoagulation with warfarin (Coumadin) is recommended to prevent thrombosis and has been shown to prolong life in patients with pulmonary hypertension primary. Patients with this condition are susceptible to pulmonary thromboembolism because of sluggish blood flow, dilated right heart chambers, veins, and the relative lack of physical activity. Maintaining the International Normalized Ratio 1.5 to 2.0 is recommended. Other anticoagulants are also being studied. Inotropic agents such as digoxin (Lanoxin) is currently being investigated. In one study, digoxin produce acute beneficial hemodynamic effects in patients with right ventricular failure and primary pulmonary hypertension, but the long-term consequences of these treatments is unknown. Parenteral drug may also be useful

Surgical therapy

Surgery bulk head between the foyer of the heart (atrial septostomy) that connects between the right atrium and left the porch can reduce the pressure on right heart but the disadvantage of this therapy can reduce blood oxygen levels (hypoxia). Lung transplantation can cure pulmonary hypertension, but this is pretty much the complications of therapy and life expectancy figures for about 5 years.

Lung transplant

Primary pulmonary hypertension is usually progressive and eventually fatal. Lung transplantation is an option in some patients younger than 65 years who have pulmonary hypertension who did not respond to medical management. According to the 1997 U.S. transplant registry report, 24 lung transplant recipients with primary pulmonary hypertension had survival rates of 73 % in one year, 55 % in three years and 45 % in five years. Directreduction of pulmonary artery pressure was associated with improvement inright ventricular function. And Recurrence primary pulmonary hypertension after lung transplantation has not been reported

Conclusion

• Pulmonary hypertension is a disease that is rarely found but because of progressive increase in pulmonary vascular resistance leading to decreasedright ventricular function because of increased right ventricular afterload.
• Pulmonary hypertension is a complex problem that is marked with signs and symptoms are not specific and has many potential causes. It can be defined asa systolic pulmonary artery greater than 30 mm Hg or pulmonary artery pressure is greater than 20 mm Hg.
• Diagnostic classification of pulmonary hypertension in according to (WHO) World Health Organization
  1. Hipertensi pulmonary artery
  2. Hipertensi pulmonary venous
  3. Pulmonary hypertension accompanied with respiratory system disorders and /  o hypoxemia
  4. Hipertensi pulmonale due to chronic thrombotic and / or disease
  5. Hiperetensi pulmonary embolism due to disorders directly affecting the pulmonary vascularization