Pulmonary Hypertension - High Blood Pressure in the Heart-to-Lung System

What is pulmonary hypertension?

Pulmonary hypertension, or PHT, is high blood pressure in the arteries going to your lungs.

Pulmonary blood pressure reflects the pressure the heart exerts to pump blood from the heart through the arteries of the lungs. In other words, it focuses on the pressure of the blood flow in your lungs. 

How blood flows through your heart and lungs

The lower right heart chamber, the right ventricle, receives oxygen-depleted blood and pumps it to your pulmonary arteries. The blood then travels to your lungs to be oxygenated and on to the upper left heart chamber, the left atrium. From there, the oxygen-rich blood moves into the lower left chamber, the left ventricle, which pumps blood to the rest of your body through the aorta.

Watch how blood flows through your heart and lungs.

The numbers in pulmonary hypertension

Pulmonary blood pressure is normally a lot lower than systemic blood pressure. Normal pulmonary artery pressure is 11-20 mm Hg at rest. If the pressure in the pulmonary artery is greater than 25 mm Hg, as measured by a cardiac catheterization, it is abnormally high and is called pulmonary hypertension.

The long-term effects of pulmonary hypertension

Similar to how systemic high blood pressure can cause the heart to work harder to deliver blood to the body, pulmonary hypertension can occur when the arteries in the lungs narrow and thicken, resisting the flow of blood through the pulmonary arteries to the lungs. As a result, the pressure in your arteries rises as your heart works harder to try to force the blood through. Heart failure occurs when the heart becomes too weak to pump enough blood to the lungs.

Symptoms of pulmonary hypertension

Symptoms include:

• Shortness of breath during routine activity
• Fatigue
• Chest pain
• Racing heartbeat
• Pain in upper right side of abdomen
• Decreased appetite
• Coughing and wheezing
• Feeling light-headed, especially during physical activity
• Fainting
• Swelling in the ankles or legs  

Diagnosis and treatment

Pulmonary hypertension can develop slowly, without early signs and symptoms. When symptoms do occur, they may be attributed to asthma or other lung or heart conditions.

To diagnose pulmonary hypertension, your health care professional may ask about your symptoms and risk factors, including other medical conditions and family history. Having a family member with pulmonary hypertension increases your risk of developing the disease.

Medical evaluation

Your physician may recommend tests and procedures to diagnose pulmonary hypertension and discover its cause and severity. Common diagnostic tests include blood tests, echocardiograph, chest X-ray, electrocardiogram (EKG) and catheterization of the right heart. Discovering the underlying cause may involve further testing.

Types of pulmonary hypertension

The World Health Organization has established five groups of pulmonary hypertension.

Group 1 pulmonary arterial hypertension (PAH)

Group 1 refers to PAH, which is caused when the arteries in the lungs become narrowed, thickened or stiff. 

Group 2 pulmonary hypertension

Group 2 pulmonary hypertension is often associated with left heart disease. 

Group 3 pulmonary hypertension

Group 3 is related to lung problems like chronic lung disease or hypoxia (low oxygen levels).

Group 4 pulmonary hypertension

Group 4 includes pulmonary hypertension caused by blood clots in the lungs or general clotting disorders.

Group 5 pulmonary hypertension

Group 5 includes pulmonary hypertension triggered by other disorders.

Factors that can affect pulmonary hypertension

While pulmonary hypertension has no cure, you can live an active, fulfilling life by working with your health care professional to manage your symptoms. Talk to your health care professional before taking over-the-counter medicine, as some can worsen symptoms of pulmonary hypertension or interfere with prescriptions. Keep a list of medicines with you. Ask whether you should get a pneumonia vaccination or flu shot. Additionally, pregnancy can pose serious risks for women with pulmonary hypertension, so be sure to discuss birth control options with your physician.

These lifestyle changes can improve your symptoms:

• Quit smoking. Your health care professional can recommend programs and products to help.
• Follow a healthy diet. Eat a variety of fruits, vegetables and whole grains, plus lean meat, poultry, fish and low-fat/fat-free milk. Your diet should be low in fat, cholesterol, sodium and sugar.
• Watch your weight. A daily record of your weight can help you be aware of rapid weight gain, which may be a sign that your pulmonary hypertension is worsening.
• Stay active. Incorporate physical activity such as walking into your lifestyle. Discuss the level of activity with your health care professional. Avoid straining or lifting heavy weights. Rest when you need to.
• Hot tubs and saunas may affect blood pressure so it’s best to discuss with your health care professional to see whether it’s recommended for you.
• Be cautious about air travel or high-altitude locales. You may need to travel with extra oxygen. Discuss any travel plans with your health care professional.
• Get support for the anxiety and stress of living with pulmonary hypertension. Talk with your health care team or ask for a referral to a counselor. A support group for people living with pulmonary hypertension can be invaluable in learning how to cope with the illness.