What Is Pulmonary Artery Pressure?
Pulmonary hypertension refers to a hemodynamic and pathophysiological state in which pulmonary artery pressure rises above a certain threshold, which can cause right heart failure. It can be an independent disease, a complication, or a syndrome. The diagnostic criteria for hemodynamics are: at sea level resting state, the average pulmonary artery pressure measured by the right heart catheter is 25mmHg. Pulmonary arterial hypertension is a common and frequently-occurring disease, and the disability and mortality rates are very high, which should be paid great attention by people.
Basic Information
- English name
- pulmonary hypertension
- Visiting department
- Cardiology, Cardiac Surgery
- Multiple groups
- Connective tissue disease, family history of idiopathic pulmonary hypertension
- Common causes
- Arterial, left heart disease, hypoxia, lung disease, chronic thromboembolism
- Common symptoms
- Dyspnea, fatigue, fatigue, impaired exercise tolerance, syncope, chest pain
Classification of pulmonary hypertension
- Pulmonary hypertension is divided into five categories based on pathological manifestations, hemodynamic characteristics, and clinical diagnosis and treatment strategies: arterial pulmonary hypertension; pulmonary hypertension caused by left heart disease; pulmonary hypertension caused by hypoxia and / or pulmonary disease; Chronic thromboembolic pulmonary hypertension; Pulmonary hypertension caused by various mechanisms and / or unknown mechanisms (see Table 1 for specific classification).
- Table 1. Classification of Pulmonary Hypertension at the 2013 World Pulmonary Hypertension Congress in Nice
Clinical manifestations of pulmonary hypertension
- Symptoms of pulmonary hypertension are non-specific, and may be asymptomatic in the early stages, with the following manifestations as the disease progresses:
- Dyspnea
- Appears first and is most common. Expressed as shortness of breath after progressive sexual activity, severe illness can also occur at rest.
- 2. Fatigue, fatigue, and decreased exercise tolerance
- Associated with reduced cardiac output and insufficient tissue perfusion.
- 3. syncope
- Decreased cardiac output leads to insufficient blood supply to the brain.
- 4. Angina or chest pain
- Caused by right heart ischemia, is associated with reduced right ventricular hypertrophy coronary arterial perfusion, and relative lack of blood supply to the heart muscle.
- 5. Hemoptysis
- Pulmonary capillary microangioma rupture.
- 6. hoarse
- Pulmonary artery dilation caused by compression of the recurrent laryngeal nerve.
- 7. Symptoms of right heart failure
- Lack of appetite, nausea, vomiting, upper abdominal pain, edema of both lower limbs, perineum, lumbosacral region, pleural and ascites fluid, lips, fingertips, auricle cyanosis, neurological symptoms, etc.
- 8. Some types of pulmonary hypertension may also have symptoms of primary disease
- Such as connective tissue disease-related pulmonary hypertension may have hair loss, light sensitivity, oral ulcers, arthritis and so on.
Pulmonary hypertension
- Laboratory inspection
- Autoantibodies, liver function and hepatitis virus markers, HIV antibodies, thyroid function tests, blood gas analysis, prothrombin time and activity, BNP or NT-proBNP.
- 2. ECG
- Prompt right ventricular overload, hypertrophy, and right atrial dilatation.
- 3. Chest radiograph
- Signs suggesting pulmonary hypertension include: the lateral diameter of the right lower pulmonary artery 15mm, the protrusion of the pulmonary artery segment 3mm, the expansion of the central pulmonary artery and the loss of peripheral pulmonary blood vessels to form a "residual root sign", the enlargement of the right atrium and the right ventricle, and an increase in the cardiothoracic ratio.
- 4. Echocardiography
- It is used to estimate pulmonary artery pressure, exclude other causes, such as congenital heart disease, valvular disease, etc., and also evaluate right heart function and determine prognosis.
- 5. Determination of lung function
- Used to identify airway and lung parenchymal lesions, with emphasis on the ability of carbon monoxide to diffuse.
- 6. Lung ventilation / perfusion scan
- Helps determine the presence or absence of pulmonary embolism.
- 7. High-resolution CT and enhanced CT
- Provides more detailed lung parenchyma and pulmonary vascular imaging information.
- 8. Magnetic resonance imaging
- The right ventricular morphology, size, and function can be directly evaluated, and some right heart hemodynamic characteristics can also be non-invasively evaluated.
- 9. Polysomnography
- Used to exclude hypoxic pulmonary hypertension.
- 10. Cardiopulmonary exercise test
- Cardiac function, gas exchange capacity, maximum oxygen consumption, and EqCO 2 can be used to predict prognosis.
- 11.6 minutes walking distance
- An important method for assessing patient exercise tolerance.
- 12. Right Heart Catheter Examination and Acute Vasodilation Test
- Right heart catheterization is the gold standard for diagnosing pulmonary hypertension, which can accurately obtain the hemodynamic characteristics of pulmonary circulation and right heart system. The acute vasodilation test is used to determine whether a patient responds to calcium blocker therapy.
- 13. Pulmonary angiography
- Exclude pulmonary embolism, pulmonary artery tumors, etc.
- 14. Thoracoscopic lung biopsy
- Not recommended for routine use.
Diagnosis of pulmonary hypertension
- 1. Identify high-risk groups of pulmonary hypertension: Those with the basic diseases listed in the classification table are all high-risk groups of pulmonary hypertension, such as those with congenital heart disease, connective tissue disease, portal hypertension, pulmonary disease, chronic pulmonary embolism, HIV Patients with basic diseases such as infections, those who take diet pills, central appetite suppressants, and those with a history of idiopathic pulmonary hypertension or hereditary pulmonary hypertension in the family.
- 2. Pulmonary hypertension screening: echocardiography.
- 3. Pulmonary hypertension diagnosis: right heart catheterization.
Pulmonary hypertension treatment
- General measures
- Rehabilitation / exercise and exercise training, psychosocial support, contraception, vaccination.
- 2. Supportive treatment
- Anticoagulant drugs, diuretics, digitalis, oxygen inhalation.
- 3. Targeted drug therapy
- At present, the drugs approved by China's State Food and Drug Administration for targeted treatment of pulmonary hypertension include:
- (1) Indications for bosentan : It is used for patients with pulmonary hypertension of types 1 and 4.
- Note: Aggravate water retention and edema. There may be liver damage. Liver function test should be performed before medication, and liver function should be checked once a month during medication. Prohibited in pregnancy or will be pregnant, women who have the possibility of pregnancy, pregnancy test should be performed once a month. This medicine also affects the effect of hormonal contraceptives, and other contraceptive methods should be adopted. Check the hemoglobin level before and during the first and third months after use, and check every three months afterwards.
- (2) Anrisentan indication: used in patients with pulmonary hypertension of type 1 and 4.
- Note: the risk of fetal malformations, strict contraception during medication, prohibited in pregnant and lactating women. There may be liver damage. Liver function test should be performed before medication, and liver function should be checked once a month during medication. Adverse reactions: fluid retention, heart failure, hypersensitivity, anemia, etc.
- (3) Iloprost indication: It is used for patients with type 1 and 4 pulmonary hypertension.
- Note: adverse reactions: vasodilation, headache, cough, hypotension. Those with abnormal liver function and renal failure should consider reducing the dose. Bleeding diseases, pregnant and lactating women are prohibited, pay attention to contraception.
- (4) Treprostinil indication: It is used for patients with pulmonary hypertension of types 1 and 4.
- Note: Adverse reactions include pain, diarrhea, jaw pain, edema, vasodilation, and nausea.
- 4. Interventional Therapy
- Congenital heart disease-related pulmonary hypertension: if there is an indication, interventional occlusion therapy can be performed.
- Chronic thromboembolic pulmonary hypertension and Takayasu arteritis involving the pulmonary arteries: those with indications, feasible pulmonary balloon dilation and stent placement.
- Balloon atrial septal ostomy: For patients with pulmonary hypertension who are still ineffective with the best combination of drugs, mRAP> 20mmHg, resting-stage patients with arterial oxygen saturation <85% are forbidden.
- 5. Surgical treatment
- Pulmonary thromboendometrial ablation: the preferred treatment for chronic thromboembolic pulmonary hypertension, with indications for cardiac function III and IV, mean pulmonary artery pressure of 30 mmHg or more, pulmonary vascular resistance> 300dyn · s / cm, and thrombus located above the lung Can be achieved by arterial surgery.
- Lung transplantation: lung transplantation is recommended for patients with pulmonary hypertension who have failed drug treatment.
Prevention of pulmonary hypertension
- Primary prevention: For the general population, promote a healthy lifestyle, quit smoking, limit alcohol, and use diet pills with caution.
- Secondary prevention: targeted at high-risk groups, especially those suffering from the basic diseases listed in the classification table, such as congenital heart disease, connective tissue disease, portal hypertension, lung disease, chronic pulmonary embolism, HIV infection, taking weight loss drugs, central Sexual appetite suppressants, those with a history of idiopathic pulmonary hypertension or hereditary pulmonary hypertension in the family, should pay attention to monitoring, actively control and treat the primary disease, and timely detect pulmonary hypertension.
- Tertiary prevention: For patients with pulmonary hypertension, the prognosis should be improved, and active treatment should be avoided to avoid factors that aggravate the condition of pulmonary hypertension, such as pregnancy, colds, and heavy physical activity.