Pulmonary hypertension: grades and classification

A person with pulmonary hypertension is in a delicate state of health. Symptoms and limitations implying the presence of this disorder vary in severity, but always careful.

The presence of this disease is established when the pressure within the pulmonary artery, which originates in the right ventricle of the heart, is greater than 25 millimeters of mercury be at rest, or greater than 30 in exertion.

This is not measurable from outside the body, as is the case with blood pressure, but more specific procedures are needed. How is it classified? What are its possible causes? Next, we detail it.

degrees of pulmonary hypertension

The severity of pulmonary hypertension is determined based on the complications experienced by a person with the disease. In ascending order, it begins with physical activity without affectation until it reaches the last degree, when the disability is continuous.

This classification is called «functional classes», and was established by New York Heart Association in collaboration with the World Health Organization. Since its publication, almost every country in the world has accepted it as valid.

The functional classes of this diagnostic protocol are the following:

  • First degree: In this case, the patient with pulmonary hypertension has no difficulty in carrying out regular physical activities, without extreme efforts. In general, there is no shortness of breath or wheezing and no chest pain.
  • Second degree: Physical limitations already appear here. Although minimal, they tend to occur when activity begins, with chest pain and shortness of breath disappearing when rest.
  • Third grade: Functional class III of this classification determines that patients have many problems performing daily activities, such as walking a few blocks or climbing stairs. Fatigue is common and recovery time is longer.
  • Fourth Degree: the biggest severity The clinic occurs when the person with pulmonary hypertension has shortness of breath and chest pain even at rest, without performing any physical activity.
degrees of pulmonary hypertension
Pulmonary hypertension evolves over time. It doesn’t cause much trouble at first, but later causes shortness of breath, chest pain, and other complications.

Classification of origin of pulmonary hypertension

In 2003 a world meeting laid the foundations for the classification of pulmonary hypertension, which will then be completed in 2008 in what has been defined Dana Point Clinical classification of hypertension. These parameters are intended to clarify the etiology of this pathology in each particular case.

AS, The lawsuits were divided into four large groups: arterial, venous or left heart, associated with respiratory diseases, associated with thromboembolic disease and multifactorial. Each of these groups contains many other subtypes.

Pulmonary arterial hypertension

This group is the one that has generated the most scientific discussion. His way of establishing origins has changed over the years, with the 2008 consensus being the most widely accepted today.

The most discussed variety is the one called idiopathic. It is a pulmonary arterial hypertension in which the concrete causesgiven that the patient does not have genetic alterations or other pathologies that explain the increase in blood pressure within the pulmonary artery.

On the other hand, there are hereditary or genetic types. It was possible to determine mutations in the genes BMPR2 AND ALK1 which are transmissible in the same family, forming groups at risk between grandparents, parents and children.

Here we also have substances that increase pulmonary artery pressure. Some are drugs prescribed to treat other conditions, such as phenylpropanolamine or hormone replacement therapy estrogen. Others are recreational drugs, such as cocaine.

Finally, this first group includes pulmonary hypertension due to some disorders that have problems with the pulmonary arteries as symptoms. Connective tissue diseases make up the largest subgroup, in which we have lupus, scleroderma, dermatomyositis, and even Rheumatoid arthritis.

In the newborn, it is by far the congenital heart disease that accounts for the largest number of cases. These are children born with morphological alterations of the heart and great vessels, including the pulmonary artery.

From the left side of the heart

This second group of the classification includes pathologies of the left atrium and the ventricle of the heart. Although the pulmonary artery arises from the right side, all the heart chambers work together and the pressures balance each other.

If there are alterations in the valves on the left side, long-term increases in blood pressure may appear on the right side. THE valve diseasewhich can be stenosis (narrowing) or insufficiencies (failure to stop the flow), delay the normal emptying of blood into the arteries, and therefore are a cause.

Associated with respiratory diseases

The pulmonary artery begins its course in the right ventricle and from there goes to the lungs. It carries blood with carbon dioxide which the alveoli will expel out of the body and exchange with oxygen, which will return to the heart through the left side of it.

Chronic lung diseases hamper this process and increase the pressure inside the pulmonary artery., which has to make a greater effort to complete its passage through the tissue of the lungs. Sometimes, there is also momentary pulmonary hypertension due to acute conditions.

Here we have to mention chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, obstructive sleep apnea syndrome and altitude sickness. The solution and treatment, in these cases, lies in addressing the root cause.

Associated with respiratory diseases
The presence of chronic lung disease is a risk factor for pulmonary hypertension.

Pulmonary hypertension with thromboembolic disease

Pulmonary thromboembolism is the presence of a clot in the lung tissue from another site. The process involves the formation of a clot, usually in the lower limbs, which travels through the bloodstream.

The traveling clot is called an embolus and its impact on the lungs is severe. There is a life-threatening lack of air. Pulmonary arterial pressure increases for the same reason as in the previous group of the classificationas more force is required to break through the obstructed lung tissue.

For multifactorial reasons

The last group of the classification includes various disorders, conditions and pathologies that determine the appearance of pulmonary hypertension due to different paths. Among the many examples, the most recognized are the following:

  • Hematological diseases
  • Sarcoidosis
  • Gaucher disease
  • hypothyroidism
  • Mediastinitis with fibrosis
  • Dialysis for kidney failure

a serious condition

Pulmonary hypertension has different origins, but is always serious. Medical attention is mandated from the first minute of its discovery and must be continued chronically.

Not only pulmonologists are the specialists involved. A complete team includes doctors, cardiologists and physiotherapists. Sometimes also rheumatologists, hematologists and infectologists, depending on the etiology. The complexity requires multidisciplinary participation and rigorous patient involvement.

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