Pulmonary Hypertension (PHT)

This condition involves the elevation of pressure in the lung circulation. In the first instance, it may reflect back pressure from the left side of the heart into the lung circulation. The prime symptom is that of breathlessness and ankle swelling. In such cases, there may be evidence of either mitral or aortic valve disease, or left sided heart failure causing the breathlessness. Certainly, one would consider earlier valve interventions in the presence of PHT. The commonest cause of PHT however, is the presence of pre-existing chronic lung disease such as emphysema or chronic bronchitis. This restricts the flow of blood through the lung circulation, causing right heart failure (cor pulmonale). Such patients would often have leg swelling. Patients who have had previous clots on the lung (pulmonary embolism) should be considered. A patient may have had a previous lung clot. Totally silently, especially if anticoagulants have been stopped, chronic embolism can gum up the lung circulation, causing PHT.  Much less commonly, pure PHT can occur. In young women with unexplained breathlessness, primary PHT should be considered. More rarely, certain drugs, other inflammatory (rheumatoid) conditions, chronic liver disease, and HIV disease can cause this condition. In all such patients, an echocardiogram would be the first investigation to make the diagnosis.

In the absence of known lung disease, or left heart failure, specialist advice should be obtained for unexplained PHT.