Warning Signs of Pulmonary Hypertension and How To Treat It

Pulmonary hypertension is high blood pressure that affects the arteries and veins of the lungs and, eventually, the right side of the heart. Because the disease worsens over time and has no cure, it’s important to understand the warning signs, diagnosis and treatment. 

What Is Pulmonary Hypertension? 

Pulmonary hypertension is different from “regular” hypertension (high blood pressure) because pulmonary hypertension mainly affects arteries and veins in the lungs, while high blood pressure involves the constriction of arteries throughout the whole body. You can develop pulmonary hypertension at any age. Women, non-Hispanic Black people and anyone 75 or older are at higher risk. 

Symptoms of pulmonary hypertension develop slowly and are often minor at first. These symptoms include: 

• Shortness of breath

• Fatigue

• Chest pain or pressure

• Fainting

• Bluish tint to lips or skin

• Feeling lightheaded

• Swelling in the ankles, also called edema 

• As pulmonary hypertension worsens, so do the symptoms. 

Because symptoms can resemble more common conditions like asthma or other heart problems, often pulmonary hypertension isn’t diagnosed until it becomes more severe. 

How Doctors Diagnose Pulmonary Hypertension 

Some of the tools used to diagnose hypertension are: 

• Medical exam and evaluation of medical history

• Chest X-ray

• Echocardiogram (ultrasound of the heart)

• Electrocardiogram (EKG)

• Catheterization of the right heart

• Lung function testing

• Lung scans to identify chronic blood clots 

Once you’ve received a diagnosis, treatment depends on which type of pulmonary hypertension you have and the underlying cause.  Your doctor will also prescribe dietary modifications, exercise and other methods of mitigating symptoms to manage fluid balance and oxygen levels. 

• Group 1 (pulmonary arterial hypertension) is typically treated with very specialized medications that dilate the lung arteries and slow down the progression of disease.  Patients receiving these medications should be seen by a pulmonary hypertension specialist. 

• Group 2 (left heart disease) is treated with therapies that focus on the underlying heart disease. 

• Group 3 (lung disease) is treated with therapies aimed at the underlying lung disease. 

• Group 4 (chronic clotting) may be treated with surgical removal of blood clots as well as medications that dilate the arteries and thin the blood preventing formation of new clots. 

• Group 5 (miscellaneous) is treated by addressing any underlying conditions. 

In a very small number of patients who have not responded to medications, lung transplant may be an option. 

Complications from Untreated Pulmonary Hypertension 

Several complications can be associated with pulmonary hypertension, including: 

• Heart failure

• Blood clots

• Kidney failure

• Arrhythmia (irregular heartbeat)

• Bleeding in the lungs

• Pregnancy complications 

In cases of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, appropriate treatment is essential as few patients survive beyond five years without treatment.  

Identification of pulmonary hypertension in other groups is also necessary as relieving elevated right-sided heart pressure helps with shortness of breath and improves ability to participate in daily activities. 

Since symptoms of pulmonary hypertension — and your risk of developing complications — worsen over time, it’s a good idea to speak with a healthcare provider at the first sign of pulmonary hypertension. 

If your doctor is treating you for shortness of breath or chest pain, and it's not getting better, or if you start getting unexplained leg swelling or get dizzy while walking or doing your regular exercise routine, talk to your health care provider about getting an echocardiogram, which can screen for pulmonary hypertension.