Pulmonary hypertension (PH) is a broad term that refers to high blood pressure in the pulmonary arteries. These are the vessels that transport oxygen-depleted blood from your heart to your lungs.
There are numerous causes of pulmonary hypertension. It is typically a complication of heart or lung disease. However, many other diseases and environmental factors can increase your chances of developing PH.
Because it disrupts the flow of blood through your heart and lungs, pulmonary hypertension is dangerous. High blood pressure in your pulmonary arteries causes them to narrow. As a result, your heart must work harder to deliver oxygen-depleted blood to your lungs.
PH damages your heart over time and causes problems throughout your body. Without treatment, it can be fatal.
What effects does pulmonary hypertension have on my body?
Pulmonary hypertension can lead to a variety of health issues, including:
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There are blood clots in your pulmonary arteries.
Effusion of the pericardium.
Pregnant women should avoid taking PH. It can be dangerous for both the birthing parent and the fetus.
Without treatment, pulmonary hypertension can overwork your heart and lead to death. High pulmonary artery blood pressure makes your heart work harder to send oxygen-depleted blood to your lungs. This blood is pumped to your lungs by your right ventricle (lower right chamber). As a result of the extra work, PH causes your right ventricle to grow in size over time. Right ventricular hypertrophy can result in right-sided heart failure.
Right-sided heart failure causes a chain reaction throughout your body. It has the potential to disrupt the normal functioning of numerous organs and systems.
Because pulmonary hypertension can have a wide-ranging impact on your health, it’s critical that you get diagnosed and treated as soon as possible. Your doctor will prescribe treatment based on the cause of your PH. Untreated PH, regardless of the cause, is lethal.
What are the various forms of pulmonary hypertension?
The World Health Organization (WHO) classifies pulmonary hypertension into five categories based on its etiology.
PH in Group 1 caused by pulmonary arterial hypertension (PAH). PAH can be caused by a variety of factors, including underlying diseases and certain drugs. PAH causes your pulmonary arteries to narrow, thicken, and stiffen. Because less blood can flow through, the pressure in your pulmonary arteries rises.
Group 2 PH as a result of left-sided heart disease. The left side of your heart circulates blood throughout your body. A problem on this side of your heart affects the right side of your heart and the entire pulmonary circuit. The pressure in your pulmonary arteries rises as blood backs up in your heart.
Group 3 PH as a result of lung disease or hypoxia. Certain lung conditions cause the arteries in your lungs to constrict. Because less blood can flow through your lungs, the pressure in your pulmonary arteries rises.
Group 4 PH is caused by pulmonary blockages. Blood clots or scars from blood clots prevent normal blood flow through your lungs. This increases the workload on the right side of your heart and raises pulmonary blood pressure.
Other disorders have caused Group 5 PH. PH can coexist with other conditions such as blood disorders and metabolic disorders. The precise mechanisms by which the condition causes PH are not always clear.
Who is affected by pulmonary hypertension?
Adults of any age can develop pulmonary hypertension. It usually affects people who have heart or lung problems. It is also more prevalent in people who have other medical conditions. PH has an impact on:
Almost all people with severe mitral valve disease.
Aortic valve disease affects approximately 65% of people.
Scleroderma affects up to 30% of people.
Around 20% to 40% of sickle cell disease patients.
One in every 200 people has HIV.
Adults are most commonly affected by PH. However, it can occasionally affect newborns. This is known as newborn persistent pulmonary hypertension (PPHN). Infants with this condition may require intensive care unit treatment.
What is the prevalence of pulmonary hypertension?
Some types of PH are uncommon, such as pulmonary arterial hypertension (PAH) and clot-related PH. Other types, however, are far more common, particularly PH caused by heart or lung problems.
We don’t know how many people worldwide suffer from pulmonary hypertension. However, according to some estimates, PH may affect one out of every 100 people. This equates to 50 million to 70 million people suffering from PH.
PH is even more common in the elderly. Around the world, one in every ten adults over the age of 65 has PH.
The number of people diagnosed with PH is expected to rise in the coming decades, according to researchers.
CAUSES AND SYMPTOMS
What are the initial signs of pulmonary hypertension?
Shortness of breath during daily activities is the first sign of pulmonary hypertension. These may include stair climbing or grocery shopping. When you exercise, you may also feel out of breath.
You may not have any symptoms at the start of pulmonary hypertension. When you do notice symptoms, they may be minor. However, PH symptoms worsen over time, making it difficult to carry out your normal activities.
What are the complications of pulmonary hypertension?
As your PH worsens, you’ll experience shortness of breath even when you’re not moving. Other signs and symptoms include:
A bluish hue on your skin or lips.
Pain or pressure in the chest.
Feeling dizzy or faint.
I’m not feeling as hungry as usual.
Tummy ache on the upper right side.
The heartbeat is racing.
Edema (swelling) in your ankles, legs, or stomach.
PH symptoms make it difficult to exercise or go about your daily activities.
What is the progression of pulmonary hypertension?
Pulmonary hypertension is classified into four stages. These are referred to as “functional classes” by the World Health Organization (WHO). They are based on your symptoms and refer to how well you can perform your daily activities. As your PH worsens, the symptoms become more visible and disruptive to your daily life.
Class 1: You have no symptoms.
Class 2: You have no symptoms when you are resting. However, you experience discomfort or shortness of breath during certain routine activities. Household chores and stair climbing are examples.
When you’re resting, you might still feel fine. However, it is now much more difficult to perform routine tasks because you are tired or short of breath.
Class 4: You experience symptoms even when you are sleeping. When you try to do any normal task, the symptoms worsen.
What is the cause of pulmonary hypertension?
The causes of pulmonary hypertension vary greatly depending on the type of PH. They include a variety of diseases, underlying conditions, and environmental exposures (toxins and drugs).
PH in Group 1 caused by pulmonary arterial hypertension (PAH)
Pneumatic arterial hypertension can be caused by a variety of factors. They are as follows:
Heart defect at birth.
Diet pills such as “fen-phen” (which can cause PAH years after use).
Mutations in the human genome.
Diseases of glycogen storage.
The disease of the liver.
Hypertension in the portal vein.
Hemangiomatosis of the pulmonary capillaries.
Pulmonary veno-occlusive disease.
Recreational drugs like methamphetamine.
Some people develop PAH without any clear cause. These cases are known as “idiopathic.”
Group 2 PH due to left-sided heart disease
Heart problems are a common cause of pulmonary hypertension. Because the left and right sides of your heart work together, a problem with the left side also affects the right side. The right side of your heart is responsible for pumping blood into your pulmonary arteries. So, left-sided heart problems cause a chain reaction that affects the rest of your heart, your pulmonary arteries and your lungs.
Left-sided heart problems that can cause pulmonary hypertension include:
Aortic valve disease. Your aortic valve connects your left ventricle (your heart’s main pumping chamber) to your aorta. Your aorta is the largest blood vessel in your body, and it’s responsible for sending oxygen-rich blood out to the rest of your body. With aortic valve disease, your valve may be leaky (regurgitation) or narrow (stenosis) (stenosis). Other problems like congenital heart disease and endocarditis can also affect your aortic valve.
Left-sided heart failure. This means the left side of your heart can’t pump blood as it should. Your left ventricle may be too weak, or it may be too stiff. Either way, not enough oxygen-rich blood can reach your body’s organs and tissues. Over time, left-sided heart failure can lead to right-sided heart failure and other complications.
Left ventricular hypertrophy. This is a thickening of the muscular walls of your left ventricle that makes your heart less efficient at pumping blood. It’s usually caused by long-term hypertension or other heart problems like arrhythmias.
Mitral valve disease. Your mitral valve is the door that lets blood flow from your left atrium to your left ventricle. It may become too stretchy (prolapse), leading to regurgitation. It may also become too narrow. Over time, mitral valve disease strains and damages your heart.
Group 3 PH due to lung disease or hypoxia
Lung problems are another common cause of pulmonary hypertension. Some people with left-sided heart disease also have lung disease or a lack of oxygen (hypoxia) (hypoxia).
Lung issues that can cause pulmonary hypertension include:
Chronic obstructive pulmonary disease (COPD) (COPD). This is a group of diseases that includes chronic bronchitis and emphysema. COPD makes it harder for you to breathe.
Interstitial lung disease. This means you have fibrosis, or scarring, in your lung tissue. The scarring leads to breathing problems and coughing.
Obstructive sleep apnea. This condition causes your airway to become partly or completely blocked, over and over again, as you sleep. As a result, less oxygen reaches your organs.
Group 4 PH due to blockages in your lungs
This form of PH is usually caused by chronic thromboembolic pulmonary hypertension (CTEPH) (CTEPH). CTEPH is a condition that involves blood clots and scarring in the arteries in your lungs.
A pulmonary embolism is a blood clot that travels from somewhere else in your body and gets stuck in a blood vessel in your lungs. These blood clots are often treatable, but they may leave behind scar tissue.
These scars can make it harder for blood to flow through your pulmonary arteries. As a result, the blood pressure in your pulmonary arteries goes up.
Group 5 PH due to other disorders
Many other conditions cause pulmonary hypertension in ways that scientists don’t yet understand. Scientists don’t know the exact mechanisms that cause these conditions to trigger PH. What they do know is that there’s an association between these conditions and PH. That means people with these conditions may face a higher risk of developing PH. Such conditions include:
Gaucher disease: A metabolic disorder that affects your organs and bones.
Kidney disease: Problems with the function of your kidneys.
Langerhans cell histiocytosis: A disorder that, in adults, causes scarring and cysts in your lungs.
Sarcoidosis: An inflammatory disease that usually affects your lungs and lymph glands.
Thyroid disease: Disorders that affect your thyroid’s production of hormones.
Tumors: Cancerous or benign tumors may put pressure on blood vessels in your lungs.
DIAGNOSIS AND TESTS
How is pulmonary hypertension diagnosed?
Your provider will perform a physical exam and run tests to reach a pulmonary hypertension diagnosis.
First, you’ll have a physical exam to check for signs of pulmonary hypertension as well as other heart or lung issues. During this exam, your provider will:
Ask you questions about your health and your medical history.
Ask about your symptoms.
Check the size of the veins in your neck. Bulging neck veins (jugular venous distention) could be a sign of right-sided heart failure.
Check the size of your liver by feeling the upper right area of your tummy.
Listen to your heart and lungs with a stethoscope.
Look at your belly, ankles and legs for edema.
Measure your blood pressure.
Measure the oxygen level in your blood using a pulse oximeter.
Pulmonary hypertension can be difficult to diagnose since many signs of PH are similar to those of other conditions. So, after your physical exam, your provider may run some tests to get more information.
Your provider may also refer you to a pulmonologist or cardiologist.
What tests diagnose pulmonary hypertension?
Your provider may use several different tests for different purposes.
These tests measure the blood pressure in your pulmonary arteries:
Right heart catheterization: This test is also called pulmonary artery catheterization. It measures the pressure inside your pulmonary arteries and checks how much blood your heart can pump per minute.
Doppler echocardiogram: A Doppler echo uses sound waves to show how your right ventricle is working. It also measures blood flow through your heart valves. It allows your provider to calculate your systolic pulmonary artery pressure.
These tests look for the underlying cause of pulmonary hypertension:
Blood tests: Check for a range of issues related to organ function, hormone levels and infections. Specific blood tests include a complete metabolic panel and a complete blood count.
Chest CT scan: Looks for blood clots and other lung conditions that may be causing your pulmonary hypertension or making it worse.
Chest X-ray: Shows if your right ventricle or pulmonary arteries are bigger than they should be.
Polysomnogram (PSG): This overnight sleep test checks if you have sleep apnea.
Pulmonary ventilation/perfusion (VQ) scan: Looks for blood clots in your lungs.
Your provider may also perform a six-minute walk test. This test shows how much exercise you can handle and how much oxygen is circulating in your blood as you exercise. The results indicate if your pulmonary hypertension is mild or severe.
MANAGEMENT AND TREATMENT
What is the treatment for pulmonary hypertension?
Pulmonary hypertension treatment depends on the type of PH you have and your other medical conditions. Your healthcare team will tailor treatment to your individual needs.
Right now, only two types of PH can be treated directly:
Pulmonary artery hypertension (PAH) (PAH).
Chronic thromboembolic pulmonary hypertension (CTEPH) (CTEPH).
Treatment for other types of PH involves managing the underlying medical conditions.
Treatment for pulmonary arterial hypertension (PAH) includes:
Calcium channel blockers. These medications can help lower the blood pressure in your pulmonary arteries and throughout your body.
Diuretics. These “water pills” help your body clear out extra fluid.
Oxygen therapy. You may need this treatment if you don’t have enough oxygen in your blood.
Pulmonary vasodilators. These medications help your pulmonary arteries relax and open up better. This improves blood flow and lowers the strain on your heart.
Treatment for CTEPH includes:
Anticoagulants. These medicines help prevent blood clots.
Balloon atrial septostomy (BAS) (BAS). This procedure is typically used for babies with critical heart defects. However, it’s also used for adults with pulmonary hypertension. It’s a bridge that helps keep you stable as you wait for a lung transplant.
Balloon pulmonary angioplasty (BPA) (BPA). This catheter-based procedure uses a balloon to widen your pulmonary artery. It’s usually done if you can’t have open surgery.
Medication. A soluble guanylate cyclase stimulator (SGCS) may help slow down the disease progression.
Pulmonary endarterectomy (PEA) (PEA). This surgery removes blood clots from your lungs. It’s currently the only possible cure for pulmonary hypertension, and it’s only for people with CTEPH.
Treatment for PH caused by heart or lung problems focuses on managing the underlying conditions. Because so many different heart and lung conditions cause PH, treatment plans can be vastly different from person to person. Talk with your provider about what’s best for you. In general, your provider may recommend:
Medication to manage problems like hypertension or heart failure.
Surgery, such as heart valve repair.
Treatments for PH caused by other medical conditions (WHO Group 5) are still evolving. Your provider will work with you to determine the best care plan.
A last resort option for some people with severe pulmonary hypertension is a lung transplant.
What medications treat pulmonary hypertension?
Pulmonary vasodilators are medications that treat PAH and CTEPH. They can’t be used for other types of PH, including those caused by underlying heart or lung issues.
Pulmonary vasodilators help your pulmonary arteries relax. This lowers blood pressure and eases the load on the right side of your heart.
People with PH may take a variety of other medications based on their underlying conditions.
How should I manage my pulmonary hypertension medications?
You may be taking many different medications to treat PH and other medical conditions. It can be a lot to keep track of. Here’s some advice.
Know the names of all your medications, and know how they work. Keep a list with you at all times.
Take your medications at the same time every day. If you forget to take a dose, do not take two doses to compensate. Call your service provider and ask what you should do.
Do not take any over-the-counter medications without first consulting your provider. Some cold and flu medications, as well as pain relievers, can cause complications in people with heart failure.
Any over-the-counter medications with warnings for people with high blood pressure should be avoided.
Do not discontinue any medications or make any changes to your medications without first consulting with your provider.
Herbal supplements, including herbal tea, should be avoided. Some of your medications may interact with herbal products.
What factors increase a person’s chances of developing pulmonary hypertension?
The following are risk factors for developing pulmonary hypertension:
There is a family history of blood clots.
There is a family history of pulmonary hypertension.
Tobacco smoking and use of tobacco products.
Dietary supplements such as “fen-phen” (dexfenfluramine and phentermine).
Prescription medications used to treat cancer and depression.
Recreational drug use.
Certain medical conditions increase your risk as well. These are some examples:
There are blood clots in your pulmonary arteries.
Disease of the connective tissue.
The Gaucher disease.
The disease of the liver.
The disease of the lungs.
Discuss your risk factors with your provider and what you can do to reduce your risk.
How can I avoid developing pulmonary hypertension?
Preventing pulmonary hypertension is not always possible. Some risk factors are beyond your ability to control. If you have risk factors, your provider may advise you to get preventive screenings for your heart and lungs.
Taking steps to prevent or manage other medical conditions can help reduce your risk of developing pulmonary hypertension. You can take the following steps:
Make a workout plan. Inquire with your provider about which exercises are appropriate for you.
Maintain a heart-healthy diet. Avoid processed foods, fast food, and other high-salt, high-saturated-fat foods.
Stop smoking and using tobacco. Tobacco use and smoking are major risk factors for heart and lung disease. Quitting smoking or using tobacco is difficult, especially if you’ve been doing so for a long time. However, your provider can assist in locating resources. Support groups may also be beneficial.
Take your blood pressure and other medications as directed.
PROGNOSIS / OUTLOOK
What is the prognosis for people suffering from pulmonary hypertension?
The prognosis for people with pulmonary hypertension is determined by:
The source of PH.
How early it is detected.
The seriousness of the symptoms.
Medical conditions that are related.
Each person’s perspective is unique. Talk to your doctor about your prognosis and how to manage your condition.
Is pulmonary hypertension curable?
The majority of cases of pulmonary hypertension are incurable. Medication may be prescribed by your doctor to:
Relieve your symptoms.
Enhance your quality of life.
Reduce the disease’s progression.
Your doctor may also advise you to make changes to your lifestyle.
Surgery, on the other hand, can cure some people with chronic thromboembolic pulmonary hypertension (CTEPH).
What is the average life expectancy for people suffering from pulmonary hypertension?
The average lifespan varies from person to person. It depends on how quickly you are diagnosed and whether you have any other medical conditions. Discuss with your provider what you can expect in your specific situation.
Pulmonary hypertension is a disease that worsens over time. That is, it worsens over time. Some people progress more quickly than others. Treatment can help you live with pulmonary hypertension for many years.
Is it possible to die from pulmonary hypertension?
If left untreated, pulmonary hypertension causes right-sided heart failure and, eventually, death. Treatment can help you live a longer and more fulfilling life.
LIVING IN CONNECTION WITH
What kind of follow-up care do I require?
Consult your healthcare provider about how to manage and monitor your condition. When you need to come in for checkups and tests, your provider will notify you. Inform your provider of any new or changing symptoms.
Also, consult with your service provider about:
Birth control options and whether pregnancy is safe. Pregnancy is dangerous for people who have pulmonary hypertension.
Putting together an emergency kit. People suffering from pulmonary hypertension must keep certain supplies and information on hand at all times. Inquire with your provider about what you should include in your emergency kit.
Exercise. Inquire about what is safe for you and how to incorporate exercise into your daily routine. Inquire about which exercises to avoid.
Seasonal vaccines, such as those for the flu and pneumonia. Your doctor will advise you on which vaccines you should get.
As you adjust to your “new normal” of life with pulmonary hypertension, consider joining a support group or seeking counseling. A medical diagnosis elicits a wide range of emotions. You are not required to carry them alone.
Travel arrangements. When flying in an airplane, you may need to take some precautions. You should also exercise caution when traveling to high altitudes. Consult your provider about how to prepare for travel and what to bring.
What dietary modifications should I make?
Your provider will make specific recommendations to you. One important step is to reduce your sodium intake. That is to say:
Avoid using “seasoning salt” or adding salt at the table.
Smoked, cured, salted, and canned meats should be avoided.
Purchase “low sodium” or “low salt” foods.
Limit your intake of fast food and prepared foods.
Other dietary modifications include:
Consume high-fiber foods (like whole grains, bran, fruits and vegetables).
Eat potassium-rich foods (like dried fruits, bananas and oranges).
Eat magnesium-rich foods (like peanuts, tofu and broccoli).
Reduce your intake of refined sugar, saturated fat, and cholesterol-containing foods.
When should I contact my physician?
If you are experiencing difficulties with:
A rapid heart rate (120 beats per minute).
A persistent respiratory infection or cough.
Constant dizziness or lightheadedness.
Physical activity causes episodes of chest pain or discomfort.
Extreme fatigue or a reduction in your ability to carry out your normal activities.
You may experience nausea or a loss of appetite.
Unrest or perplexity.
Shortness of breath that has worsened, particularly if you wake up feeling short of breath.
Swelling in your ankles, legs, or stomach that has worsened.
Breathing difficulties during normal activities or at rest.
gaining weight (2 pounds in one day or 5 pounds in one week).
When should I go to the emergency room?
If you have any of the following symptoms, go to the emergency room or dial 911.
A persistently high heart rate (120-150 beats per minute).
Fainting spells accompanied by loss of consciousness.
Intravenous prostacyclins cause Hickman catheter complications. Infection, catheter displacement, solution leak, bleeding, and IV pump malfunction are examples of these.
Shortness of breath that persists even after rest.
Chest pain that comes on suddenly and is severe.
A severe and sudden headache.
Arms or legs experience sudden weakness or paralysis.
A message from the Cleveland Clinic
A diagnosis of pulmonary hypertension can elicit a wide range of emotions. It takes time to process the diagnosis, understand what’s going on inside your body, and decide how to proceed. Collaborate with your provider to obtain the resources you require. Involve your family and friends in your new lifestyle. Inform them about your condition. Most importantly, recognize that it is acceptable to seek assistance and rely on others as you adjust to your new normal.
Home>Nursing homework help
D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights in the last week and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually, his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.
Case Study 1 Questions:
According to the case study information, how would you classify the severity of D.R.’s asthma attack?
Name the most common triggers for asthma in any given patient and specify in your answer which ones you consider applied to D.R. in the case study.
Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.
Fluid, Electrolyte, and Acid-Base Homeostasis:
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:
Serum glucose 412 mg/dL
Serum sodium (Na+) 156 mEq/L
Serum potassium (K+) 5.6 mEq/L
Serum chloride (Cl–) 115 mEq/L
Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/L
Case Study 2 Questions:
Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance she has? Name all of them based on the lab results and clinical presentation.
Describe the signs and symptoms of the different types of water imbalance, and describe the clinical manifestation she might exhibit with the potassium level she has.
In the specific case presented which would be the most appropriate treatment for Ms. Brown and why? Include both pharmacologic and non-pharmacologic approaches.
What do the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Based on your readings and your research define and describe Anion Gaps and their clinical significance.
This assignment has 2 case studies. You must work and include both case studies in your initial post.
Your initial post should be at least 500 words for each case study