How is pulmonary hypertension recognized?

For some time my mother has suffered from difficulty in breathing, fatigue, cyanosis (bluish skin and mucous membranes) and heavy legs. She did an echocardiogram which revealed no heart problems, but PAPs (systolic pressure in the pulmonary artery) 38 mmHg and the doctors suspect pulmonary hypertension. If this were indeed the case, would the situation be serious? What should we expect? I would also like to know what other tests the mother could do to arrive at a definitive confirmation of the diagnosis, which for now is only hypothesized.

He answers Antonella CaminatiMedical Director of the Pneumology Operating Unit, San Giuseppe Hospital, Milan (GO TO THE FORUM)

Pulmonary arterial hypertension means an increase in pressure in the pulmonary arterial vessels, which normally operate at low pressure. The presence of pulmonary hypertension must be confirmed by the reference examination that right heart catheterization. We start talking about pulmonary hypertension when the mean pulmonary pressure (evaluated precisely with right heart catheterization) exceeds 20-25 mmHg. This condition subjects the right ventricle (responsible for pumping blood to the lungs at low pressure) to an overload of pressure that can lead to contractile insufficiency and decompensation.

The causes and symptoms

There are many causes of pulmonary hypertension: they exist idiopathic forms (the cause of which is unknown), secondary forms a pulmonary embolisms chronic relapses and forms secondary to chronic lung diseases that condition low saturation values ​​in a constant way, such as chronic obstructive bronchitis (BPCO), pulmonary emphysema, idiopathic pulmonary fibrosis (Ipf) and other forms of fibrosing interstitial disease, systemic diseases such as pulmonary sarcoidosis and autoimmune forms (mainly scleroderma and systemic lupus erythematosus), chronic liver diseases with portal hypertension, HIV infection. Some drugs can also cause pulmonary hypertension (anorectics, inhibitors of reuptake serotonin) and some stimulants (cocaine, amphetamines). Symptoms of pulmonary hypertension are non-specific and common to many other cardiovascular and pulmonary diseases: shortness of breath with exertion and even at rest, asthenia, posterior sternal weight sense, orthopnea (difficulty in breathing while lying down) and sloping edema (in the lower parts of the body); in the advanced stages also episodes of syncope (temporary loss of consciousness), which indicate the severity of the disease.

Effective therapies

L’echocardiogram represents the screening test for the diagnosis but then there is a whole series of tests that must be performed to ascertain the specific cause (blood tests with autoimmunity and D-dimer, blood gas analysis, global spirometry + Co diffusion, walking test, CT scan chest with contrast medium). THEThe right cardiac catheterization allows to confirm or not the presence of pulmonary hypertension by direct measurement of pulmonary pressure. important to make an early diagnosis; depending on the cause, the treatment changes but today, in many cases, There are several very effective therapies available. To come to his mother, I would say that in-depth investigations are necessary. Then, if the diagnosis is confirmed, the severity of the picture and the therapeutic possibilities will be assessed.