Pulmonary hypertension

Pulmonary hypertension (PH) is characterized by an increase in blood pressure in the lungs. It can be acute or chronic.

The acute form often occurs in hospitals in the intensive care unit or in the operating room. Apart from increased blood pressure in the lungs, it can be linked to the narrowing of the pulmonary vessel or heart problems. It is a life-threatening situation for the patient, and action must be taken immediately.

A proliferation of cells in the wall of the small pulmonary arteries causes chronic PH. This progressive remodeling leads to obstruction of the vessels, which increases vascular resistance in the lungs. It leads to heart and lung malfunctions, which can be fatal.

Different forms of pulmonary hypertension

Pulmonary hypertension can get complex as there are many types of origin.

Go through the slider to discover some of the different forms of pulmonary hypertension and their causes.
Pulmonary Hypertension (PH)

Pulmonary circulation moves blood between the heart and the lungs and has a central role in gas exchange and blood oxygenation. In comparison to systemic circulation, which moves blood between the heart and the rest of the body, pulmonary circulation must be low pressure and relatively vasodilated.

Pulmonary hypertension (PH) is a pathophysiological disorder with high blood pressure in the lungs that disrupts pulmonary circulation.
Pulmonary Arterial Hypertension (PAH)

Pulmonary arterial hypertension (PAH) is a specific subgroup of pulmonary hypertension (PH), where pulmonary hypertension is associated with the narrowing of the lung’s small blood vessels. This distinct chronic or acute dysfunction promotes a common pathological triad: vasoconstriction, cellular proliferation, and thrombosis. PAH affects 3% of total PH patients.
Acute vs. Chronic Pulmonary Arterial Hypertension
Even if the ways in which acute and chronic PAH are similar, acute pulmonary arterial hypertension (APAH) is distinctive because it differs in its causes, clinical presentation, diagnostic findings, and response to treatment. Acute PAH may be observed in the following clinical situations:
- Persistent pulmonary hypertension of newborns (PPHN)
- Cardiopulmonary surgery (PAH)
- Acute respiratory distress syndrome (ARDS)
Persistent Pulmonary Hypertension in Newborns (PPHN)

PPHN is a serious breathing condition in which the lung vessels of newborns do not open wide enough after birth, meaning that oxygen and blood flow are restricted. One symptom is that the baby's skin is blue.

This syndrome may arise spontaneously or be secondary to a number of maternal or postnatal risk factors. PPHN is associated with significant long-term morbidities in up to 25% of infants, including neuro-developmental impairments and hearing difficulties, and is responsible for 1/3 of all neonatal mortality.

The importance of adequate treatment

A severe elevation of pulmonary arterial pressure induces a vicious circle that may lead to visceral failure, severe systemic dysfunction, and ultimately cardiogenic shock, which can be fatal.

Acute pulmonary arterial hypertension also increases risks during and after an operation.

Even though some cases of PAH are qualified as rare disorders, their occurrence is a serious concern for all healthcare organizations. Acute PAH is a true emergency and its fast and effective control is vital for patients.

What is the right treatment for APAH?

When acute pulmonary arterial hypertension (APAH) is monitored or observed in patients in an intensive care unit or operating theater, treatment must be quickly initiated. Luckily, acute pulmonary arterial hypertension is reversible. However, it requires an immediate reaction with resuscitation efforts and supportive measures aimed to improve and stabilize.

Treatment of PAH requires the following:

Oxygenation
Blood pressure management

With regards to these challenges and objectives, there are different ways with specific pulmonary vasodilator agents that are useful both to modulate pulmonary pressures and reduce heart workload, for example, inhaled nitric oxide.

Inhaled nitric oxide

Q&A

What is the priority: acute or chronic PAH?

Patients with acute pulmonary arterial hypertension are as important as chronic class IV patients, but the case is reversible.

For that reason, acute requires an immediate reaction with resuscitation efforts and supportive measures aimed to improve and first stabilize.

Can PAH be prevented?

Sometimes, with early detection and treatment of diseases or other causes, PAH can be prevented. But when PAH is already a monitored disorder, it will be treated nevertheless.

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