Pulmonary hypertension - an increase in the average blood pressure in the pulmonary artery over 20 mmHg.Art.alone and greater than 30 mm Hg.Art.under load.In this article we will discuss the symptoms and the main features of pulmonary hypertension in humans.In addition, we will tell you about the treatment of pulmonary hypertension.
Treatment of pulmonary hypertension
Treatment of pulmonary hypertension drugs
For the treatment of inflammatory corticosteroids in small doses are used for pulmonary hypertension symptoms, antihistamines, aspirin, which also improves the rheological properties of blood and microcirculation.
Bronchodilators for the treatment of pulmonary hypertension increases the permeability of the bronchial tubes.The drug of choice for pulmonary hypertension symptoms - aminophylline, which also has a vasodilator effect in the pulmonary artery, stimulates the respiratory center, increases renal blood flow, urine output.It is used for the treatment of pulmonary hypertension and
Mucolytic drugs (acetylcysteine mukosolvin bromhexine and others.) For the treatment of pulmonary hypertension symptoms facilitate sputum.Are useful in the treatment of pulmonary hypertension, inhalation (steam, soda), postural drainage, breathing exercises.After joining the symptoms of right heart failure circulatory administered cardiac glycosides and diuretics.The dose of cardiac glycosides in treating pulmonary hypertension is usually smaller than other etiology of heart failure, and is chosen individually for clinical effect: dyspnea, stagnation in the lungs and liver, swelling, increase urine output, reducing the size of the heart.
Diuretics are used to treat pulmonary hypertension with symptoms of right heart failure with caution so as not to cause excessive hemoconcentration, which can increase blood viscosity, and promote the emergence of thrombosis associated with a slowing of circulation.All drugs antihypertensives for the treatment of pulmonary hypertension signs, causing decreased blood pressure in a large circle, and reduce the pressure in the arteries of a small circle.
Currently, the treatment of moderate pulmonary hypertension calcium antagonists used with success in the treatment of symptoms and severe pulmonary hypertension - long-acting nitrates.Calcium antagonists (verapamil, nifedipine, etc.) have a relaxing effect on the smooth muscles of the bronchi and pulmonary vessels.They are to some extent have the properties of peripheral vasodilators, ingibiruyug release of mediators from mast cells of the lung, inhibit the output of histamine from basophils blood of antigen inhibit histamine release from sensitized cells.
long-acting nitrates (nitrong, sustak, Erin) reduce the load capacity of the right ventricle by reducing venous return, reduce the load resistance while eliminating the hypoxic vasoconstriction, reduce the pressure in the left atrium due to a decrease in end-diastolic pressure in the left ventricle.
diuretics for the treatment of pulmonary hypertension
Diuretics are used to reduce the severity of symptoms of right heart failure.However, care must be taken when appointing them to treat as large diuresis in patients with symptoms of pulmonary hypertension can reduce the preload on the right ventricle and reduce cardiac output.Assign furosemide 20-40 mg / day orally, hydrochlorothiazide 50 mg / day orally.
blockers of slow calcium channel blockers in the treatment of pulmonary hypertension
blockers of slow calcium channels can reduce the pressure in the pulmonary artery in primary pulmonary hypertension.Indicated for the treatment of pulmonary hypertension nifedipine dose of 30-240 mg / day, a dose of diltiazem at 120-900 mg / day.
Cardiac glycosides for the treatment of pulmonary hypertension
Cardiac glycosides do not have any significant positive effect on the treatment of pulmonary hypertension.They can be used in small doses in atrial fibrillation to slow the heart rate.It should be remembered that patients with signs of pulmonary hypertension resulting in hypoxemia and hypokalemia during treatment with diuretics rapidly evolving glycoside intoxication.
Alternative methods of treatment of pulmonary hypertension
how to conduct oxygen therapy to treat the symptoms of pulmonary hypertension?When hypoxemia (without hypercapnia) oxygen therapy treatment is carried out for 50 - a 60% humidified oxygen at 6 - 9 L / min.In the case of hypercapnia oxygen concentration is reduced to 24 - 30%.In violation of repolarization shows the use of resources, improve the metabolism in tissues (vitamins, Riboxinum, potassium orotate, etc.) And microcirculation (antiplatelet drugs, including anticoagulants) for the treatment of the symptoms of this type of hypertension.
how to conduct bloodletting to treat pulmonary hypertension? Bleed for the treatment of pulmonary hypertension is carried out at an elevated venous pressure (jugular venous pulsation of the liver), polycythemia with a hematocrit greater than 55%, the growth of circulatory failure.First bleeding is usually not less than 500 ml, after 2 - 3 days 200 - 300 ml.All patients with circulatory insufficiency with pulmonary hypertension treated with anticoagulants direct (heparin) and indirect (sinkumar et al.) Action.
dose heparin for the treatment of selected individually from 5000 to 15,000 IU.in such a way that the clotting time lengthened to 1.5 - 2 times as compared with the norm.Prevention of symptoms of chronic pulmonary heart disease is to prevent the onset and progression of chronic nonspecific pulmonary diseases, particularly chronic obstructive.
When should surgical treatment of pulmonary hypertension symptoms? With the ineffectiveness of therapeutic interventions for the treatment of lung transplantation is a complex or "heart-lung".
Prediction treatment of pulmonary hypertension
Prediction treatment of pulmonary hypertension depends on the cause of pulmonary hypertension, as well as the level of pressure in the pulmonary artery.Five-year mortality of patients with chronic diseases of the lungs at an average pressure in the pulmonary artery to 25 mm Hg.Art.It is 10-15%, and at 30-45 mm Hg.Art.- 60%.When symptoms of primary pulmonary hypertension five-year survival is 22-38%.
Causes of pulmonary hypertension
pulmonary hypertension can be either acquired (secondary) and innate (primary).The reasons for the pressure increase of symptoms in the pulmonary artery can be heart disease (congenital and acquired malformations, heart failure), chronic lung disease (COPD, asthma, interstitial pulmonary fibrosis, sarcoidosis, asbestosis, silicosis, tuberculosis), vasculitis, stay in the highlands,PE, the impact of drugs.When the cause is not possible to identify the symptoms of pulmonary hypertension, talk about the treatment of primary pulmonary hypertension.
When valvular disease, symptoms of passive pulmonary hypertension as a result of pressure transmission from the left atrium to the pulmonary veins, and then to the pulmonary artery system.When mitral stenosis holes in some cases there is a reflex spasm of arterioles lungs due to increased pressure in the mouths of the pulmonary veins and the left atrium (Euler-Liliestrandta reflex).When long-existing pulmonary hypertension formed irreversible organic sclerotic changes ateriol their obliteration.In congenital heart disease pulmonary hypertension occurs due to increased blood flow in the pulmonary artery and increase resistance to blood flow in the pulmonary vessels.
In CHD, dilated cardiomyopathy, hypertension occurs as left ventricular failure leads to pulmonary hypertension as a result of increasing pressure in the left atrium and pulmonary veins.
In chronic respiratory diseases pulmonary hypertension for a long time is compensatory in nature, as hypoxic pulmonary vasoconstriction (Euler-Liliestrandta reflex) off of lung perfusion unventilated areas than eliminates shunting of blood in them, reduces hypoxemia.At this stage, the use of aminophylline reduces compensatory vazonstriktsii, reduce the pressure in the pulmonary circulation and the rise of intrapulmonary shunting of blood to the deterioration of oxygenation.With the progression of lung disease pulmonary hypertension in a hypoxemia (hypoxic myocardium) becomes a factor in the pathogenesis of the formation of chronic pulmonary heart disease.
Symptoms of pulmonary hypertension
main symptoms of pulmonary hypertension
main symptom of pulmonary hypertension - shortness of breath, having the characteristic features:
- present alone;
- amplified with little physical exertion;
- retained in the sitting position (unlike cardiac dyspnea).
Besides dyspnea, patients can be confusing for the following symptoms of pulmonary hypertension:
- dry (nonproductive) cough - a common symptom of pulmonary hypertension.
- Chest pain (due to expansion of the trunk of the pulmonary artery and right ventricular myocardial ischemia).
- Edemas on the legs, pain in the right upper quadrant (due to increased liver) are a symptom of pulmonary hypertension.
- There may be signs of hoarseness in patients with pulmonary hypertension due to compression of the recurrent laryngeal nerve advanced pulmonary artery trunk.
- Patients may experience symptoms of syncope during exercise, because the right ventricle is not able to increase cardiac output adequately to the needs of the increasing under load.
Symptoms of pulmonary hypertension
What symptoms manifested pulmonary hypertension?
On examination reveals signs of cyanosis (due to arterial hypoxemia, and decreased cardiac output).The essential difference of a heart lung cyanosis feel symptoms of peripheral vasodilation resulting hypercapnia symptoms, so hand in patients with pulmonary hypertension is usually warm.You can also identify the ripple: epigastric - hypertrophied right ventricle, in II intercostal space left of the sternum - the pulmonary artery trunk.If symptoms of severe heart failure reveal jugular veins on both inhalation and exhalation (a characteristic feature of right heart failure).There are also peripheral edema and hepatomegaly.
Diagnosis of pulmonary hypertension
inspection for symptoms of pulmonary hypertension:
Auscultation of the heart with symptoms of pulmonary hypertension
Auscultation often exhibit the following symptoms:
- Systolic "click" and accent II tone of the pulmonary artery (the latter can be determined andpalpation).
- fixed (independent of respiratory phases) splitting II tone.
- in II intercostal space left of the sternum listen systolic ejection murmur.There is possible a soft diastolic murmur valve insufficiency of the pulmonary artery.
- listen systolic murmur in the projection of tricuspid valve with pulmonary hypertension as a result of its failure (increases noise on inspiration).
X-ray study of pulmonary hypertension signs
X-ray examination reveals symptoms of pulmonary artery trunk extension and the roots of the lungs.Radiological signs of pulmonary hypertension is considered the expansion of the descending branch of the right pulmonary artery more than 16-20 mm.
ECG for symptoms of pulmonary hypertension
ECG can be changed as a result of pulmonary hypertension, heart rotation and disposition due to emphysema, changes in blood gas, myocardial ischemia, metabolic disorders.Keep in mind that a normal ECG does not exclude pulmonary hypertension.It is possible to detect signs of P-pulmonale (high P wave in leads II, III, aVF, Vi), axis deviation to the right, the signs of right ventricular hypertrophy (high R waves in leads Vi_3 and deep teeth S in leads Vs-e), signsblockade of the right leg Heath beam axis of the heart such as S1S2S3 (pronounced presence of teeth in both S I, II, III standard leads).
Echocardiography in the treatment of pulmonary hypertension
echocardiography to determine the dilatation of the right atrium and right ventricle, to identify the last wall thickening (5-6 mm), determine the pressure in the right ventricle and the pulmonary artery trunk using the Doppler method in pulmonary hypertension.
catheterization of heart cavities with signs of pulmonary hypertension
reliable diagnosis method for symptoms of pulmonary hypertension is pulmonary artery catheter through the veins of the systemic circulation and direct manometry.At the same time revealed increased pressure in the pulmonary artery and pulmonary artery wedge pressure is normal or low.