Pulmonary Hypertension occurs when the pressure in the circulation rises to high with or without reason.
Hypertension is considered as an increase in blood pressure.
When blood flows through the Pulmonary Circulation it goes through the pulmonary artery, pulmonary vein, and/or the pulmonary capillaries.
Often the result is having a high blood flow but at the same time a low pressure.
This allows for a large increase in volume when exercising but does not actually cause a huge increase in blood pressure.
Smooth Muscle line the pulmonary circulation to help allow for constriction and dilation when necessary.
Once present, it often results in a “backing-up” problem leading to additional consequences
Can be classified as Primary or Secondary pulmonary hypertension depending on cause
It can be one of five types:
1.      Arterial
2.      Venous
3.      Hypoxic
4.      Thromboembolic
5.      Miscellaneous
The Venice 2003 Revised Classification system Illustrates that Five types
WHO group IÂ Â Â Â Â Â Â Â – Â Pulmonary arterial hypertension (PAH)
WHO group IIÂ Â Â Â Â Â -Â Â Pulmonary hypertension associated with left sided heart disease
WHO group IIIÂ Â Â Â -Â Â Pulmonary hypertension associated with lung diseases and/or hypoxemia
WHO group IVÂ Â Â Â Â Â -Â Â Pulmonary hypertension due to chronic thrombotic and/or embolic disease
WHO group VÂ Â Â Â Â Â Â Â -Â Â Miscellaneous
“Proceedings of the 3rd World Symposium on Pulmonary Arterial Hypertension. Venice, Italy, June 23-25, 2003” (2004). J. Am. Coll. Cardiol. 43 (12 Suppl S): 1S–90S. doi:10.1016/j.jacc.2004.02.037. PMID 15194171.
Symptoms
-Â Â Â Difficulty breathing
-Â Â Â Painful breathing
-Â Â Â Breathing can be worse with exercise and better at rest
-Â Â Â Fatigue
-Â Â Â Dizziness
-Â Â Â Syncope
-Â Â Â Cough
-Â Â Â Coughing of blood
-Â Â Â Edema
Diagnosis
X-rays and CT scans can be helpful
Dilation of arteries may be seen
Echocardiography can evaluate the heart
Doppler Ultrasonography helps with the pressure
The exact pressure can be determined only by heart catherization
Causes:
·    Pulmonary Embolism
·    Sickle Cell disease
·    Pericarditis
·    Mitral stenosis
·    Left sided Heart Failure
·    Polycythemia
·    HIV
·     Hepatic Cirrhosis
·     Portal Hypertension
·    Emphysema
·    and others
Treatment:
The use of medications largely depends on condition and underlying cause – not all medications would be used in all populations;
Those suffering Heart Failure
Diuretics
Beta-Blockers
ACE Inhibitors
Pulmonary Arterial Hypertension
Anticoagulants
.        Digoxin
Diuretics
.        Adenosine
.        Epoprostenol
Calcium Channel Blockers
Vasoactive Substances are for patients that have abnormal constriction with smooth muscles
·        Endothelin receptor antagonists
·        Phosphodiesterase type 5 inhibitors
·        Prostacyclin derivates
Prostaglandins
·        Epoprostenol  [Flolan]
·        Treprostinil  [Remodulin]
·        Iloprost  [Ilomedin] IV
·         Iloprost  [Ventavis]
Endothelin receptor antagonists
Phosphodiesterase type 5 inhibitors