Pulmonary hypertension (PH) is a chronic and progressive condition associated with unusually high pressure in the blood vessels that carry blood to the lungs from the heart. This restricts blood flow to the lungs, limiting effective oxygen transport throughout the body.
As it is a progressive disease, the initial symptoms of PH may be mild enough not to be noticed or be attributed to another condition. But if left untreated, the symptoms can steadily worsen.
The disease has many potential causes, and these can affect how it progresses and what symptoms may be present. Some of the common symptoms of PH include shortness of breath, excessive fatigue, weakness, chest pain, and fainting.
Shortness of breath (dyspnea)
As PH impairs oxygen transport, patients usually experience shortness of breath with everyday activities, such as climbing stairs.
At later stages of the disease, patients may find themselves short of breath even while at rest. Disease severity or stage is associated with the patient’s exercise ability.
Due to abnormally low levels of oxygen, some patients may have blue-colored lips or skin, a condition called cyanosis.
High blood pressure in the pulmonary vessels creates more strain on the heart so that it can continue to pump blood through the lungs. This strain can cause the enlargement, or hypertrophy, of the heart’s right ventricle, making it increasingly weak. Consequently, PH can lead to heart failure later in life.
Patients may also experience heart palpitations (pounding heartbeat) and arrhythmia, which refers to irregular heartbeat. These complications can lead to dizziness or fainting.
As strain on the heart increases, patients may start feeling chest pain or pressure. This symptom usually occurs in the front of the chest, mainly during exercise.
In some patients, chest pain was found to be strongly correlated with the increased size of the heart and pulmonary arteries.
Muscle weakness and fatigue
Muscle weakness has also been reported in people with PH. This symptom occurs particularly in respiratory muscles, such as the diaphragm — located below the lungs — and limb muscles, and may affect the exercise capacity and quality of life of patients.
Patients often feel fatigue, or lack of energy, with routine tasks.
Risk factors for fatigue related to PH include a high body mass index — a measure of body fat — oxygen use, and some treatments. Scoring high on the New York Heart Association functional classification, meaning the presence of symptoms even with less-than-normal physical activity, has also been associated with fatigue.
Cough and hoarseness
Due to compression of the airways by enlarged pulmonary vessels, people with PH may also have asthma-like symptoms, such as dry cough and wheezing. These symptoms may complicate the course of PH and can be resistant to typical asthma therapy, such as steroids and bronchodilators (treatments that open the airways).
Sometimes, patients may also cough up blood, a condition called hemoptysis.
The compression of a nerve in the chest by an enlarged pulmonary vessel may lead to hoarseness, which refers to a raspy, strained voice.
Swelling, or an abnormal buildup of fluid, in the ankles, legs, and abdomen is also among the possible signs of PH.
This symptom, also known as edema, is caused by the increased strain on the heart that makes it not pump blood efficiently, causing fluids to accumulate in the body.
Despite high blood pressure in the pulmonary arteries, people with PH usually have low blood pressure, or hypotension, in the rest of the body.
Some patients may experience Raynaud’s phenomenon associated with PH. This results in painfully cold or numb fingers and toes, as the arteries supplying the extremities narrow, leading to reduced blood flow when exposed to cold or stress.
Last updated: June 15, 2021
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