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Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary arterial hypertension – The Complications

Pulmonary arterial hypertension
Pulmonary arterial hypertension is a subgroup of a specific subgroup of pulmonary hypertension (PH) defined as a condition of slowly progressive disorder as a result of abnormally high blood pressure in the blood vessel, including pulmonary artery, pulmonary vein, or pulmonary capillaries, that carries blood from the heart to the lungs due to narrowing in diameter of most of the very small arteries throughout the lungs of that increased resistance to blood flow, leading to right heart failure and death. Because the phrase pulmonary arterial hypertension is long and pulmonary hypertension is a bit shorter the phrase. Pulmonary hypertension is often used in place of pulmonary arterial hypertension(a). According to statistic, approximately over 1,000 new cases of pulmonary arterial hypertension are diagnosed each year, in the United States alone.
A. Complications
1. Right-sided heart failure
Pulmonary arterial hypertension (PAH) is a progressive disease in which increased pulmonary arterial pressure and remodelling eventually lead to right heart failure and death. Idiopathic and familial PAH occur far more frequently in women than in men(12).
2. Sudden Cardiac Death
According to the study by the Onassis Cardiac Surgery Center, Pulmonary Arterial Hypertension (PAH) is a disease of small pulmonary arteries, characterized by vascular proliferation and remodeling. Progressive increase in pulmonary vascular resistance ultimately leads to right ventricular heart failure and death(13).
3. Arrhythmia
Cardiac arrhythmias are important contributors to morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Such patients manifest a substrate resulting from altered autonomics, repolarization abnormalities, and ischemia. Supraventricular arrhythmias such as atrial fibrillation and flutter are associated with worsened outcomes, and maintenance of sinus rhythm is a goal(14).
4. Bleeding and thrombosis
According to the study by DRK Kliniken Berlin Köpenick, On one hand, thrombosis is one of the key pathophysiologic features of PAH (besides vasoconstriction, proliferation and inflammation). On the other hand, the incidence of bleeding events is increased in PAH patients(15).
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Sources
(a) http://pulmonaryhypertensionrn.com/ph-vs-pah/
(8a) http://www.ncbi.nlm.nih.gov/pubmed/23625955  
(12) http://www.ncbi.nlm.nih.gov/pubmed/23625955
(13) http://www.ncbi.nlm.nih.gov/pubmed/23271814
(14) http://www.ncbi.nlm.nih.gov/pubmed/23009914
(15) http://www.ncbi.nlm.nih.gov/pubmed/19335748