Pulmonary Hypertension
Pulmonary Hypertension is a condition wherein the systolic pulmonary artery pressure exceeds 30mm Hg or the mean pulmonary artery pressure exceeds 25 mm Hg. Unlike blood pressure which can be measured through a BP apparatus, pulmonary hypertension is measured during a right – sided heart catheterization.
Causes:
The following conditions are the primary causes of pulmonary hypertension:
- Raynaud’s phenomenon
- Dysfunctional or altered immune mechanisms
- Use of oral contraceptives
- Collagen diseases
- Silent pulmonary emboli
- Sickle cell disease
On the other hand, these conditions or diseases serve as secondary causes of pulmonary hypertension:
- Reduction of the pulmonary vascular bed (must input 50% to 75% of the vascular bed)
- Vasculitis
- Tumor emboli
- Sarcoidosis
- Pulmonary emboli
- Systemic sclerosis
- Interstitial lung diseases
- Pulmonary vasoconstriction due to hypoxemia
- Obesity
- COPD (Chronic Obstructive Pulmonary Diseases)
- Neuromusmuscular Disorders
- Diffused interstitial pneumonia
- Smoking or secondary smoking
- Kyphoscoliosis
- High altitude
- Primary cardiac diseases
- Congenitally acquired defects or diseases
- Atrial septal defect
- Patent ductus arteriosus
- Ventrical sceptical defect
- Congenitally acquired defects or diseases
- Acquired diseases
- Left ventricular failure
- Myxoma
- Mitral stenosis
- Rheumatic valvular disease
Manifestations:
The following presentations 9signs and symptoms) are what pulmonary hypertensive patients’ exhibit:
- Dysnea with exertion (during early stages)
- Dyspnea at rest (later stage)
- Substernal chest pain
- Syncope
- Occasional hemoptysis
- Weakness
- Fatigue
- Peripheral edema
- Ascites
- Distended neck veins
- Liver engorgement
- Crackles
- Heart murmur
Assessment and Diagnosis:
To verify the presence of a pulmonary hypertension, the following assessment and diagnostic tools are used:
- History taking
- Physical assessment
- Chest X-ray
- Pulmonary function studies – PaO2 is decreased, a normal or decreased vital capacity and lung compliance
- Electrocardiogram (ECG) – reveals right ventricular hypertrophy, right axis deviation, and tall peaked P waves, tall R waves, depressed ST segment and T wave inversion
- Echocardiogram – assess the progression of the disease and can rule out any other diseases
- Cardiac catheterization – shows elevated pulmonary arterial pressure
- Ventilation – perfusion scan – identifies defects in the pulmonary vasculature
- Lung biopsy
Medical Management:
- The main objective of the treatment is to treat the underlying cause.
- Oxygen supplementation is provided.
- Input and output is monitored. Fluid restriction may be initiated.
- Pulmonary function studies closely monitored
- Anti – coagulant therapy is administered
- Intravenous prostacyclin, cardiac glycosides and vasodilators are given.
Nursing Management:
- Nurses should be able to identify patients who are at risk for pulmonary hypertension such as those with underlying diseases like COPD, valve defects and heart diseases.
- Signs and symptoms should be keenly assessed and continuously monitored.
- Oxygen inhalation should be initiated appropriately.