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
• 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:

1. History taking
2. Physical assessment
3. Chest X-ray
4. Pulmonary function studies – PaO2 is decreased, a normal or decreased vital capacity and lung compliance
5. Electrocardiogram (ECG) – reveals right ventricular hypertrophy, right axis deviation, and tall peaked P waves, tall R waves, depressed ST segment and T wave inversion
6. Echocardiogram – assess the progression of the disease and can rule out any other diseases
7. Cardiac catheterization – shows elevated pulmonary arterial pressure
8. Ventilation – perfusion scan – identifies defects in the pulmonary vasculature
9. Lung biopsy

Medical Management:

1. The main objective of the treatment is to treat the underlying cause.
2. Oxygen supplementation is provided.
3. Input and output is monitored. Fluid restriction may be initiated.
4. Pulmonary function studies closely monitored
5. Anti – coagulant therapy is administered
6. Intravenous prostacyclin, cardiac glycosides and vasodilators are given.

Nursing Management:

1. 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.
2. Signs and symptoms should be keenly assessed and continuously monitored.
3. Oxygen inhalation should be initiated appropriately.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

What Do You Think?