Pulmonary Hypertension is a medical zebra. Consider Pulmonary Hypertension
If you see...
- Exercise intolerance
- Edema of ankles/feet or legs
- Chest pain
- Exertional light-headedness or syncope
- Clinical signs of right-sided heart failure
Then you should be thinking of PH
Unfortunately, the symptoms of PH are quite similar to those of many other lung and cardiac diseases, like asthma and coronary disease. This can make a diagnosis of PH more difficult. However, the existence of any of these symptoms can suggest the presence of PH, especially in patients with risk factors for PH.
PH Risk Factors
Many types of PH are more common in women than in men (Matura et al.). For example, the REVEAL registry found that the ratio of pulmonary arterial hypertension (PAH) in women to men was as high as 4.3:1. The reason for the increased prevalence in women is unknown.Age
PH can strike at age, from birth to late in life, but is most common in middle-aged people.Family History
Some forms of PH are more common in families, such as the heritable form of pulmonary arterial hypertension (PAH). Thus, a family history of PH or premature cardiac death should prompt assessment for PH, especially when symptoms of PH are present.Associated Conditions
There are many conditions and illnesses associated with an increased risk of developing PH. These include patients with a history of heart diseases, lung diseases, liver diseases, HIV infection, or connective tissue diseases such as scleroderma.Pregnancy
Pregnancy is commonly associated with worsening of pre-existing PH due to the strain inflicted on the body, specifically the lungs and heart. Additionally, in some women, PH symptoms first become apparent during pregnancy.Altitude
Living at high altitude is a risk factor for PH. Lower environmental oxygen levels at high altitude can lead to chronic blood hypoxia, which causes pulmonary vasoconstriction leading to the development of PH.Obesity
Obesity is associated with several conditions that increase the risk of PH. Obesity is a significant cause of heart disease, which commonly leads to PH. Moreover, sleep apnea is more common in obese patients and is a risk factor for PH because of recurrent hypoxia during sleep leading to pulmonary vasoconstriction.Pulmonary Embolism
Patients with a history of pulmonary embolism are at risk of developing a form of PH known as chronic thromboembolic pulmonary hypertension (CTEPH). PH should be suspected in patients who experience persistent dyspnea or exercise limitation despite long-term (>3 months) anticoagulation following an episode of pulmonary embolism, especially multiple or recurrent emboli.Drugs
Patients treated with some kinds of medications, including chemotherapy for cancer and certain diet drugs, are at higher risk of PH. Additionally, use of recreational drugs such as methamphetamines and cocaine is becoming a more common cause of PH.