There are two main types of pulmonary vascular disease: pulmonary embolism and pulmonary hypertension.
Pulmonary embolism occurs when blood clots block off artery branches in the lungs, often as a result of venous thrombosis in the legs or elsewhere.
The cause of pulmonary hypertension is high blood pressure in the pulmonary arteries that carry blood from the heart to the lungs. At the same time, the right side of the heart may be damaged, so that it cannot ensure the effective circulation of blood throughout the body. This can lead to heart failure and death.
Pulmonary embolism may be asymptomatic, or the following symptoms may occur:
- shortness of breath;
- coughingblood ;
- acceleratedheartbeat ;
- speeded upbreathing ;
Symptoms of pulmonary hypertension can be:
- shortness of breath;
- fastfatigue ( tiredness );
- reduced ability to do physical work;
- coughingblood ;
Usually, pulmonary embolism is caused by a blood clot (thrombus) in the leg or pelvis. Such a thrombus can tear off and move along the venous system in the direction of the pulmonary arteries. For some groups of people, the risk of blood clots is especially high; these are, in particular, elderly people, people who have survived certain diseases or surgical interventions, because of which they had to be in bed for a long time, people who are prone to blood clots, and people who receive hormone replacement therapy or oral contraceptive therapy.
The causes of pulmonary hypertensionrange from a person ‘s genes, other existing conditions or in some cases, there is no known cause (idiopathic).
There are many different forms of pulmonary hypertension, and they are treated quite differently. Doctors distinguish five main types of pulmonary hypertension:
- Pulmonary arterial hypertension (PAH) due to various causes
- Pulmonary hypertension due to heart disease
- Pulmonary hypertension associated with pulmonary diseases or lack of oxygen (hypoxia)
- Chronic thromboembolic pulmonary hypertension, in which the blood vessels are blocked by blood clots or narrowed
- Pulmonary hypertension of unknown etiology or due to several different causes
To reduce the likelihood of blood clots and, consequently, the occurrence of pulmonary emboli, prophylactic agents such as heparin may be prescribed. After a pulmonary embolus, drugs that suppress the action of vitamin K can be prescribed to reduce the risk of blood clots. Currently, oral anticoagulants are being developed, which will be easier to prescribe and which can be less controlled.
People with chronic lung diseases should receive oxygen therapy as prevention of the development of pulmonary hypertension. Methods for the prevention of pulmonary arterial hypertension does not yet exist.
Pulmonary embolism is often difficult to diagnose. When diagnosing, doctors evaluate the identified symptoms, study the patient’s medical history, conduct routine examinations, in particular, chest x-rays and an ECG.
Other tests are also performed for verification. in particular, a blood test for thrombosis and fibrinolysis D- dimer to exclude pulmonary embolism, and computed angiography, x-ray imaging, computed tomography and magnetic resonance imaging (MRI).
In emergency situations, so -called bedside echocardiography is performed to diagnose pulmonary embolism , in which an image of the heart is obtained using ultrasound. In addition, ultrasound helps to check whether there are blood clots in the veins of the legs or in the pelvic veins, which can lead to a pulmonary embolus.
For the treatment of pulmonary embolism, you can use drugs called anticoagulants. If breathing is difficult, additional oxygen may also be administered. People with chronic heart failure and high risk of pulmonary embolism are recommended so-called. thrombolytic drugs that can dissolve blood clots in the pulmonary arteries. If none of these methods helps, the possibility of surgical removal of a blood clot remains.
Early diagnosis of pulmonary arterial hypertension (PAH) is hampered by the fact that in many patients the symptoms are mild or absent, or the patients simply look physically weak. PAH can develop at any age, but the average age of a person diagnosed with PAH is 50 years. Doctors rely on symptom analysis, but take into account other factors, such as age and concomitant diseases. Many people go to the doctor too late, when symptoms of right heart failure are already detected.
If a patient has pulmonary hypertension, it is possible to use two methods to facilitate diagnosis. The first method is This is an echocardiography, during which a moving image of the heart is created using sound waves. The second method is this is a right-sided catheterization of the heart, an invasive procedure during which a thin tube is catheter – is injected into the right side of the heart to evaluate the effectiveness of the discharge, and into the pulmonary artery for measuring blood pressure.
Early screening for pulmonary hypertension can be made easier by screening programs that identify people most at risk for pulmonary hypertension.
Treatment methods for pulmonary hypertension do not yet exist, but standard drugs, such as anticoagulants, and additional oxygen can be used. Patients with pulmonary arterial hypertension can be treated with specific drugs called prostacyclins ( endothelin receptor antagonists ) or type 5phosphodiesterase inhibitors .
If pulmonary hypertension is caused by chronic thromboembolic disease, a surgical procedure called pulmonary endarterectomy , during which the blood vessels (arteries ) of the lungs are cleansed from blood clots and sutures , can help .
If the disease is severe, a lung transplant may be indicated. If pulmonary hypertension is associated with long-term heart or lung disease, treatment of this underlying disease is recommended.
- In Europe, from 6 to 20 cases of pulmonary embolism per 10,000 population are recorded annually.
- 7% – 11% of patients with pulmonary embolism die.
- The incidence of pulmonary arterial hypertension in Europe is 1.5–5.2 for every 100,000 people.
- Pulmonary arterial hypertension is more common in women than in men.
- In the absence of specific treatment, the average life expectancy of patients with pulmonary arterial hypertension is 2.8 years.
- Although pulmonary arterial hypertension is considered a rare disease, the overall mortality rate for all types of pulmonary hypertension is unknown.
- Mortality from pulmonary hypertension is underestimated in both developed and developing countries.
- It is necessary to develop more advanced methods for the diagnosis of pulmonary emboli.
- Thrombosis prophylaxis with low molecular weight heparin significantly reduces the risk of venous thromboembolic diseases in patients at risk and, therefore, the risk of pulmonary embolism.
- Increased awareness of pulmonary hypertension is of great importance for the early diagnosis and treatment of this disease.
- More research is needed to determine the causes of pulmonary hypertension.
- New methods of treatment of pulmonary arterial hypertension are needed, as long as they do not exist at all.
- It is necessary to improve prevention methods for people with an increased risk of pulmonary hypertension.