Pulmonary hypertension

1. PULMONARY
HYPERTENSION

2. out line:
INTRODUCTION
BRIEF HISTORY
WHAT IS PH?
WHAT CAUSES PH?
SIGNS AND SYMPTOMS
DIAGNOSIS OF PH
TREATMENT OF PH

3. In the human body, there are two types of
circulation that enable distribution of
blood throughout the body.
The portion that pumps oxygenated blood
from the left side of the heart via the left
ventricle to all parts of the body is known
as the systemic circulation
Introduction

4. Introduction
On the other hand, the portion that
pumps deoxygenated blood from the
right side of the heart via the right
ventricle into the lungs to obtain
oxygen is referred to as the
PULMONARY CIRCULATION .

5. Millions of people are affected by a
condition known as high blood
pressure (hypertension) whereby the
blood travels through the body’s
arteries at a pressure higher than
normal.
INTRODUCTION

6. Pulmonary hypertension is a less common type of
high blood pressure that affects the arteries in
the lungs.
Pressures in the lung arteries are normally
lower than the pressures in the systemic
circulation.
Pulmonary hypertension occurs when the
pressure in the pulmonary circulation becomes
abnormally elevated.

7. This disease can occur in men, women and
children of all ages. However, it is most
common in females between 20 and 40 years
old.
The condition is rare in children but is
sometimes seen in infants born with heart
defects. Pulmonary hypertension may be a
primary or secondary cause of hypoxia in
neonates.

8. Ordinarily, blood vessels in the lungs provide less
resistance to blood flow than blood vessels in the rest of
the body . And blood pressure is usually much lower in
the lungs. While pressure in general circulation is about
120/80 mm Hg, in the pulmonary arteries, it is only
around 25/15 mm Hg.
Mean (average) pulmonary artery pressure
= number between highest and lowest pressures
Normal
at rest : 14 mm Hg
Pulmonary hypertension
at rest : 25 mm Hg during exercise : 30 mm Hg

9. Types of pulmonary hypertension

10. Primary Pulmonary Hypertension
 no underlying cause for the high blood pressure
in lungs
 Begin with spasm of the muscle layer in
pulmonary arteries
 patients are sensitive to substances that cause
blood vessels to constrict
 may have an inherited predisposition for the
disease

11. causes of Secondary Pulmonary
Hypertension
• results directly from another medical
problem
•Chronic Obstructive Pulmonary Disease,
scleroderma, pulmonary fibrosis, lung
diseases such as asbestosis in this
diseases flow of blood impedes through the
lungs.

12. WHAT CAUSES
PULMONARY
HYPERTENSION?

13. Causes of secondary PH
blood clots in the lungs (pulmonary emboli)
 chronic obstructive pulmonary disease such as
emphysema
 Connective tissue disorders, such as scleroderma
Upper airway obstructed during sleep
 obesity with reduced ability to breathe
lung diseases such as pulmonary fibrosis (causes
scarring in the tissue between the lungs’ air sacs)

14. Left-sided heart failure
• heart’s left ventricle weakens and cannot
pump out enough blood
• increase in pressure backs up blood through
pulmonary veins to arteries in lungs
Conginital heart disease

15. Pathophysiology of pulmonary
hypertension

16. Abnormally high BP in pulmonary arteries
Increased pressure damages large and small pulmonary
arteries
Thickness of Blood vessel walls
Cannot transfer oxygen and carbon dioxide normally
Levels of oxygen in blood fall
Constriction of pulmonary arteries
increase in pressure in pulmonary circulation

17. Pulmonary Hypertension
right side of heart must work harder push blood through
pulmonary arteries to
lungs
right ventricle thickens
and enlarges
cor pulmonale
Heart Failure
In some people, the bone marrow will produce more red blood cells to
compensate for less of oxygen in blood.
Extra RBCs cause the blood to become thicker and stickier, further increasing
the load on the heart Pulmonary Embolism

19. Functional Classification
A.Class I- Patients with pulmonary hypertension but without
resulting limitation of physical activity. Ordinary physical
activity does not cause undue dyspnoea or fatigue, chest pain,
or near syncope.
B. Class II- patients with pulmonary hypertension resulting in
slight limitation of physical activity. They are comfortable at
rest. Ordinary physical activity causes undue dyspnoea or
fatigue, chest pain, or near syncope.
C. Class III- patients with pulmonary hypertension resulting in
marked. Limitation of physical activity. They are comfortable at
rest. Less than ordinary activity causes undue dyspnoea,
fatigue, and chest pain or near syncope.
D. Class IV -patients with pulmonary hypertension with inability to
carry out any physical activity without symptoms. these
patients manifest signs of right heart failure. Dyspnoea and /or
fatigue may be present even at rest. Discomfort is increased by
any physical activity

20. SIGNS AND
SYMPTOMS

21. Signs and symptoms
 shortness of breath fatigue or light-
headed upon exertion
 dizziness or fainting spells (syncope)
 swelling (edema) in ankles, legs and
eventually in abdomen (ascites) – fluid leak
out of veins and into tissues
 bluish colour to lips and skin (cyanosis)

22.  coughing (sometimes with blood) and
wheezing
 distended neck veins
 enlarged liver
 heart palpitations
 Chest pain
 feel weak – body tissues not receiving
enough oxygen


23. DIAGNOSIS OF PH

24. history of present illnesses
 past medical history
 Family history
 Any past or present medications that
the patient may have taken
physical examination will also take
place.

25. Chest X-Ray

26. Echocardiography (Ultrasonic Cardiography)

27. Electrocardiogram (ECG)
ECG is a record of the electrical activity produced by the
heart. Abnormal rhythms (arrhythmias) may indicate that
the heart or part of the heart is undergoing unusual
stress.

28. Pulmonary Angiogram
Used to measure circulation in the lungs and to visualize
clots in the lung on x-rays. The test involves insertion of
a thin catheter into the pulmonary artery through which
an iodine dye is injected.
Image of any blood clots present in the lung can be
observed and circulation of blood through lung’s blood
vessels can be tracked.

29. Pulmonary Function Tests
Non-invasive tests to measure how much air
your lungs can hold and the airflow in and out of
your lungs. They can also measure the amount
of gases exchanged across the membrane
between the lung wall and capillary membrane.
During the tests, the patient will be asked to
blow into a spirometer. An abnormality here may
be amongst the first indication of PH.

30. TREATMENT OF PH

31. fluid restriction
 diuretics to decrease fluid accumulation
 cardiac glycosides (eg, digitalis) in an attempt
to improve cardiac function
 calcium channel blockers for vasodilation,
 and rest.
Intravenous prostacyclin helps to decrease
pulmonary hypertension by reducing
pulmonary vascular resistance and pressures
and increasing cardiac output

32. Anticoagulants such as warfarin have
been given to patients because of chronic
pulmonary emboli.
Heart— lung transplantation has been
successful in select patients with primary
hypertension who have not been responsive
to other therapies

33. Lung and heart for transplant

34. Nursing Management

35. THANK YOU FOR YOUR ATTENTION!!