Secondary pulmonary hypertension

Secondary Pulmonary Hypertension
Specialty	Pulmonology, Cardiology
Symptoms	Shortness of breath, fatigue, chest pain, swelling of the legs
Complications	Right-sided heart failure, arrhythmia
Causes	Underlying heart or lung conditions, chronic thromboembolic disease
Diagnostic method	Echocardiography, Right heart catheterization
Treatment	Treat underlying cause, oxygen therapy, medication
Medication	Anticoagulants, Vasodilators, Diuretics

Secondary pulmonary hypertension (SPH) is a complex type of pulmonary hypertension that arises as a consequence of other medical conditions. These conditions can include diseases of the left heart, lung diseases, and chronic thromboembolic disease. Unlike primary pulmonary hypertension, which is considered idiopathic, secondary pulmonary hypertension has identifiable causes.

Causes

Secondary pulmonary hypertension is caused by an increase in pressure in the pulmonary arteries due to an underlying condition. Common causes include:

• Heart failure - particularly failure of the left side of the heart which leads to increased pressure in the pulmonary circulation.
• Chronic obstructive pulmonary disease (COPD) - which can cause hypoxia leading to vasoconstriction and increased pulmonary artery pressures.
• Interstitial lung disease - leading to decreased lung function and hypoxia.
• Chronic thromboembolic disease - obstruction of pulmonary vessels can lead to increased resistance against which the right heart has to pump.

Symptoms

Symptoms of secondary pulmonary hypertension may include:

• Dyspnea (shortness of breath)
• Fatigue
• Chest pain
• Swelling of the legs (due to right heart failure)
• Syncope (fainting spells)

Diagnosis

Diagnosis of secondary pulmonary hypertension typically involves:

• Echocardiography - to estimate the pulmonary artery pressures and assess the function of the heart.
• Right heart catheterization - the definitive test for measuring the pressure in the pulmonary arteries and assessing the severity of pulmonary hypertension.

Treatment

Treatment of secondary pulmonary hypertension focuses on managing the underlying cause. This can include:

• Oxygen therapy - to manage hypoxia.
• Medications such as anticoagulants to prevent thromboembolic events, vasodilators to lower pulmonary artery pressure, and diuretics to reduce fluid overload.
• In severe cases, lung transplantation or heart-lung transplantation may be considered.

Prognosis

The prognosis for patients with secondary pulmonary hypertension varies depending on the underlying cause and the severity of the condition. Early diagnosis and management of the primary disease are crucial for improving outcomes.

See also

• Pulmonary hypertension
• Right-sided heart failure
• Chronic obstructive pulmonary disease
• Heart failure