Pulmonary hypertension causes the heart to overwork and this can eventually lead to heart failure. Experts, in this report by SADE OGUNTOLA, say sometimes shortness of breath or lightheadedness may be indicative of a high blood pressure that occurs exclusively in the lungs.
wHEN Mrs. Margaret Martins complained to her gynecologist of difficulty in breathing, he thought her symptoms were caused by fibroids, which were also causing bleeding and low blood count. After a month of taking iron tablets, her blood count became normal but the symptoms worsened.
At another hospital with her husband, the doctor told her that the fibroid was not the problem. It was her heart. She was diagnosed with pulmonary hypertension.
Mr. Benson Hammed, a healthy 57-year-old, who had not been to a hospital in over 10 years, immediately knew something was wrong when he started experiencing pressure in his chest late one night in August. He thought he might be having a heart attack.
Doctors at his private hospital found that Mr. Hammed’s heart was in perfect condition, but that his lungs were in trouble. He had blood clots in the arteries of the lungs, what they medically said was referred to as pulmonary embolisms.
The doctor prescribed medications to help with the embolisms. But the medications did not help. Rather his breathing became laborious, even when he was lying down. Back at the hospital, the doctor wrote more tests to be carried out at a teaching hospital and the tests came back confirming pulmonary hypertension, a form of high blood pressure in the lungs caused by thickened blood clots in the pulmonary arteries.
Pulmonary hypertension is elevated blood pressure that occurs exclusively in the lungs. It is a deadly condition that affects an estimated 75 million people worldwide. Around 80 per cent of them live in low- and middle-income countries.
Professor Olanisun Adewole, a consultant physician and pulmonologist at Obafemi Awolowo University Teaching Hospital, Ile-Ife, says pulmonary hypertension is completely different from the hypertension many people commonly talk about although both have to do with elevation in blood pressure.
According to him, “There are two blood circulations really. Systemic hypertension more or less refers to elevated pressure in that system that is responsible for carrying blood around the whole body. But pulmonary hypertension refers to an elevation in the pressure, in that component that is responsible for carrying blood from the heart to the lungs for oxygenation.”
There is the circulation that brings the blood from the lungs to the heart. When the blood gets to the heart, there is the circulation that also distributes this blood around the body. It is the pressure that is responsible for carrying blood around the whole body. Also when the blood gets back to the heart from going round the body, that blood needs to go back to the lungs so that it can get oxygen before it goes round the body again.
He stated that pulmonary hypertension is considered to be a medical consequence of several other conditions. These include left heart disease, HIV infection, sickle cell disease, blood clots, tuberculosis (TB), bilharzia or schistosomiasis, and chronic obstructive pulmonary disease, such as asthma, emphysema and chronic bronchitis.
Professor Adewole, however, added that hypertension in the lungs can be genetic, which is why having a family member with pulmonary hypertension increases the risk of developing the disease.
Although some pulmonary hypertension is of an unknown cause, he added that the use of some prescription diet drugs or illegal drugs such as methamphetamines and cocaine can also be a reason why some people develop a high blood pressure in the lungs.
A 2017 study on pulmonary hypertension prevalence, the incidence and causes in Africa in the journal, BMC Pulmonary Medicine, said that the prevalence of pulmonary hypertension is relatively high in some populations in Africa, perhaps mainly driven by left heart diseases.
Pulmonary hypertension happens at all ages, including children, and its incidence increases with age. It often develops slowly, without early signs and symptoms. Basically, symptoms of pulmonary hypertension include shortness of breath, fainting, inability to do simple physical activities such as picking up items from the floor or walking upstairs. Others include chest pain and a persistent cough.
Often, shortness of breath or lightheadedness during activity is the first symptom. As the disease worsens, symptoms can include increased shortness of breath, with or without activity.
However, he stated that these symptoms are not specific to pulmonary hypertension, and as such pulmonary hypertension is often misdiagnosed or confused with other diseases like asthma or other lung or heart conditions, leading to a delayed diagnosis and appropriate treatment.
This delay is sadly fatal because even specialised treatments are ineffective at an advanced stage of the disease. Left untreated, it may cause heart failure, which can be fatal.
He declared that a variety of tests and procedures are used to diagnose pulmonary hypertension and to identify its cause and severity. These diagnostic tests include a chest X-ray, echocardiographic and catheterisation of the right heart. But conventional hypertension medications are not effective against pulmonary hypertension.
He added, “it is not just that you are measuring blood pressure. There are chemical tests that can quickly be done that will make you suspect strongly that a patient has pulmonary hypertension. But to know its severity in terms of the number of it or if the treatment is making it come down, tests such as the echocardiographic and the cardiac catheterisation will need to be done.”
The right heart catheterisation is an invasive technique, during which a catheter is inserted into the right side of the heart through an incision made in the neck of the patient.
The cases of pulmonary hypertension are rising, but the lack of education on the disease is causing some serious concerns. There’s a lack of awareness in the primary healthcare sector and gross under-diagnosis due to a lack of resources.
Many doctors are also overwhelmed with the burden of infectious diseases in low- and middle-income countries. These working conditions can draw attention away from detecting pulmonary hypertension at an early stage.
Although not all pulmonary hypertension can be prevented, experts say that individuals can take steps to prevent it by making healthy lifestyle changes and managing high blood pressure, coronary heart disease, chronic liver disease, and chronic lung disease from tobacco use.
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