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Causes of Primary pulmonary hypertension

Contents
  1. Primary pulmonary hypertension: Introduction
  2. Causes Discussion
  3. Drugs/substances (3 causes)
  4. Risk factors
  5. Excerpts from book chapters
  6. Complication causes
  7. Causes of symptoms
  8. Related cause information

Causes of Primary pulmonary hypertension (Diseases Database):

The follow list shows some of the possible medical causes of Primary pulmonary hypertension that are listed by the Diseases Database:

Source: Diseases Database

Primary pulmonary hypertension Causes: Book Excerpts

Primary pulmonary hypertension as a complication of other conditions:

Other conditions that might have Primary pulmonary hypertension as a complication may, potentially, be an underlying cause of Primary pulmonary hypertension. Our database lists the following as having Primary pulmonary hypertension as a complication of that condition:

Primary pulmonary hypertension as a symptom:

Conditions listing Primary pulmonary hypertension as a symptom may also be potential underlying causes of Primary pulmonary hypertension. Our database lists the following as having Primary pulmonary hypertension as a symptom of that condition:

Medications or substances causing Primary pulmonary hypertension:

The following drugs, medications, substances or toxins are some of the possible causes of Primary pulmonary hypertension as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

Read more about medication causes of Primary pulmonary hypertension


What causes Primary pulmonary hypertension?

Causes: Primary pulmonary hypertension: Unknown.
Article excerpts about the causes of Primary pulmonary hypertension:
There may be one or more causes of PPH; however, all remain unknown. The low incidence makes learning more about the disease extremely difficult. Studies of PPH also have been difficult because a good animal model of the disease has not been available.

Researchers think that in most people who develop PPH the blood vessels are particularly sensitive to certain internal or external factors and constrict, or narrow, when exposed to these factors. For example, people with Raynaud's disease seem more likely than others to develop PPH; Raynaud's disease is a condition in which the fingers and toes turn blue when cold because the blood vessels in the fingers and toes are particularly sensitive to cold. Diet suppressants, cocaine, HIV, and pregnancy are some of the factors that are thought to trigger constriction, or narrowing, in the pulmonary artery. (Source: excerpt from NHLBI, Facts About Primary Pulmonary Hypertension: NHLBI)

Related information on causes of Primary pulmonary hypertension:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Primary pulmonary hypertension may be found in:

Causes of Primary pulmonary hypertension: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Primary pulmonary hypertension.

Hypertension: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Essential hypertension (95% of cases)
    –Associated with obesity, decreased physical activity, stress, and diets high in sodium or low in potassium, calcium, and/or magnesium
  • Medications (e.g., oral contraceptives, pseudoephedrine, steroids, ephedrine, NSAIDs)
  • Sleep apnea
  • Secondary hypertension
    –Chronic renal disease
    –Renal vascular disease (e.g., renal artery atherosclerosis, fibromuscular dysplasia)
    –Cushing's disease
    –Pheochromocytoma
    –Primary hyperaldosteronism
    –Hyperthyroidism
    –Coarctation of aorta: Arm pulses are stronger than leg pulses and blood pressure is significantly higher in arms than in legs
    • “White coat” hypertension
    • Pain, stress (e.g., surgery, emotional), and postexercise
      • Isolated systolic hypertension
        –More common in elderly
        –Stronger risk factor for heart disease than
        diastolic hypertension in patients >50
    • Excessive alcohol use
    • Cocaine use
      • Malignant hypertension
        –Markedly elevated blood pressure (diastolic BP >120–140 mmHg associated with papilledema)
    • Preeclampsia/eclampsia
    • Pregnancy-induced hypertension
    • Congenital adrenal hyperplasia

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hypertension: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • “White coat” hypertension: Transient, related to anxiety
  • Essential hypertension (most common cause in adolescents)
  • Obesity
    • Drugs: Amphetamines, cocaine, PCP, nicotine, corticosteroids, oral contraceptives, antidepressants, sympathomimetics (including eye and nose drops), decongestants, β-agonists, theophylline, NSAIDs, ephedra, etc.
  • Pain/distress
  • Trauma: Pain, increased ICP, or spinal cord injury
  • Surgery: Transient hypertension secondary to pain or specific procedures such as ductus arteriosus ligation or coarctation repair, renal or urinary tract surgery
  • Seizures
  • Renal etiologies
    –Chronic renal parenchymal disease: Most common in preadolescents (chronic renal insufficiency, reflux nephropathy, chronic glomerulonephritis, PCKD)
    –Acute renal disease: Poststreptococcal glomerulonephritis, nephritis, renal failure
    –Renal artery stenosis: From fibromuscular dysplasia or by external compression from tumor or hematoma
    –Congenital ureteropelvic junction obstruction
    –Renal ischemic events secondary to umbilical catheters (thrombosis/embolus)
  • Endocrine disorders: CAH, Cushing syndrome, hypo-/hyperthyroidism, hyperparathyroidism, primary hyperaldosteronism, pheochromocytoma
  • Sleep apnea
  • Volume overload
  • Hemolytic uremic syndrome
  • Pregnancy
  • Bronchopulmonary dysplasia
  • Hypercalcemia
  • Williams syndrome (multiple vascular stenosis, autoimmune vasculitis with large vessel involvement)
  • Coarctation of the aorta

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Pulse pressure, widened: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Aortic insufficiency

With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial or a ventricular gallop develop. These signs may be accompanied by chest pain; palpitations; pallor; strong, abrupt carotid pulsations; pulsus bisferiens; and signs of heart failure, such as crackles, dyspnea, and jugular vein distention. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis

With arteriosclerosis, reduced arterial compliance causes progressive widening of pulse pressure, which becomes permanent without treatment of the underlying disorder. This sign is preceded by moderate hypertension and accompanied by signs of vascular insufficiency, such as claudication, angina, and speech and vision disturbances.

Febrile disorder

A fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder.

Increased ICP

Widening pulse pressure is an intermediate to late sign of increased ICP. Although a decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (A gap of 50 mm Hg can signal a rapid deterioration in the patient’s condition.) Assessment reveals Cushing’s triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include a headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Blood pressure increase [Hypertension]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Anemia. Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.

❑ Aortic aneurysm (dissecting). Initially, this life-threatening disorder causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure. However, this increase is brief. The body's ability to compensate fails, resulting in hypotension.

Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.

❑ Atherosclerosis. With atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.

❑ Cushing's syndrome. Twice as common in females as in males, Cushing's syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It's usually caused by corticosteroid use.

❑ Hypertension. Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.

With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing of pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.

❑ Increased intracranial pressure (ICP). Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects the heart rate last, causing bradycardia (Cushing's reflex). Associated signs and symptoms include headache, projectile vomiting, a decreased level of consciousness, and fixed or dilated pupils.

❑ Myocardial infarction (MI). MI is a life-threatening disorder that may cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.

❑ Pheochromocytoma. Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.

❑ Polycystic kidney disease. Elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys; an enlarged, tender liver; and intermittent gross hematuria.

❑ Preeclampsia and eclampsia. Potentially life-threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They're defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient's baseline systolic pressure, or an increase of 15 mm Hg above the patient's baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea, and possibly seizures (eclampsia).

❑ Renovascular stenosis. Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.

❑ Thyrotoxicosis. Accompanying the elevated systolic pressure associated with thyrotoxicosis, a potentially life-threatening disorder, are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, a fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.

Other causes

❑ Drugs. Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.

HERB ALERT:Ginseng and licorice may cause high blood pressure or an irregular heartbeat. St. John's wort can also raise blood pressure, especially when taken with substances that antagonize hypericin, such as amphetamines, cold and hay fever medications, nasal decongestants, pickled foods, beer, coffee, wine, and chocolate.

❑ Treatments. Kidney dialysis and transplantation cause transient elevated blood pressure.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Hypertension: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Hypertension affects 25% of adults in the United States. If untreated, it carries a high mortality. Risk factors for hypertension include family history, race (most common in blacks), stress, obesity, a diet high in saturated fats or sodium, tobacco use, sedentary lifestyle, and aging.

Secondary hypertension may result from renal vascular disease; pheochromocytoma; primary hyperaldosteronism; Cushing’s syndrome; thyroid, pituitary, or parathyroid dysfunction; coarctation of the aorta; pregnancy; neurologic disorders; and use of hormonal contraceptives or other drugs, such as cocaine, epoetin alfa (erythropoietin), and cyclosporine.

Cardiac output and peripheral vascular resistance determine blood pressure. Increased blood volume, cardiac rate, and stroke volume as well as arteriolar vasoconstriction can raise blood pressure. The link to sustained hypertension, however, is unclear. Hypertension may also result from failure of intrinsic regulatory mechanisms:

❑ Renal hypoperfusion causes release of renin, which is converted by angiotensinogen, a liver enzyme, to angiotensin I. Angiotensin I is converted to angiotensin II, a powerful vasoconstrictor. The resulting vasoconstriction increases afterload. Angiotensin II stimulates adrenal secretion of aldosterone, which increases sodium reabsorption. Hypertonic-stimulated release of antidiuretic hormone from the pituitary gland follows, increasing water reabsorption, plasma volume, cardiac output, and blood pressure.

❑ Autoregulation changes an artery’s diameter to maintain perfusion despite fluctuations in systemic blood pressure. The intrinsic mechanisms responsible include stress relaxation (vessels gradually dilate when blood pressure rises to reduce peripheral resistance) and capillary fluid shift (plasma moves between vessels and extravascular spaces to maintain intravascular volume).

❑ When the blood pressure drops, baroreceptors in the aortic arch and carotid sinuses decrease their inhibition of the medulla’s vasomotor center, which increases sympathetic stimulation of the heart by norepinephrine. This, in turn, increases cardiac output by strengthening the contractile force, increasing the heart rate, and augmenting peripheral resistance by vasoconstriction. Stress can also stimulate the sympathetic nervous system to increase cardiac output and peripheral vascular resistance.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulmonary hypertension: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Pulmonary hypertension begins as hypertrophy of the small pulmonary arteries. The medial and intimal muscle layers of these vessels thicken, decreasing distensibility and increasing resistance. This disorder then progresses to vascular sclerosis and obliteration of small vessels.

In most cases, pulmonary hypertension occurs secondary to an underlying disease process, including:

❑ alveolar hypoventilation from chronic obstructive pulmonary disease (most common cause in the United States), sarcoidosis, diffuse interstitial disease, pulmonary metastasis, and certain diseases such as scleroderma (In these disorders, pulmonary vascular resistance occurs secondary to hypoxemia and destruction of the alveolocapillary bed. Other disorders that cause alveolar hypoventilation without lung tissue damage include obesity, kyphoscoliosis, and obstructive sleep apnea.)

❑ vascular obstruction from pulmonary embolism, vasculitis, and disorders that cause obstruction of small or large pulmonary veins, such as left atrial myxoma, idiopathic veno-occlusive disease, fibrosing mediastinitis, and mediastinal neoplasm

❑ primary cardiac disease, which may be congenital or acquired. Congenital defects that cause left-to-right shunting of blood — such as patent ductus arteriosus or atrial or ventricular septal defect — increase blood flow into the lungs and, consequently, raise pulmonary vascular pressure. Acquired cardiac diseases, such as rheumatic valvular disease and mitral stenosis, increase pulmonary venous pressure by restricting blood flow returning to the heart.

Primary (or idiopathic) pulmonary hypertension is rare, occurring most commonly — and with no known cause — in women between ages 20 and 40. Secondary pulmonary hypertension results from existing cardiac, pulmonary, thromboembolic, or collagen vascular diseases or from the use of certain drugs.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pregnancy-induced hypertension: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of pregnancy-induced hypertension is unknown, but geographic, ethnic, racial, nutritional, immunologic, and familial factors and pre-existing vascular disease may contribute to its development. Age is also a factor. Primiparas who are older than age 35 are at higher risk for preeclampsia.

Preeclampsia develops in about 7% of pregnancies. Incidence is significantly higher in low socioeconomic groups. About 5% of females with preeclampsia develop eclampsia; of these, about 15% die from PIH itself or its complications. Fetal mortality is high due to the increased incidence of premature delivery and uteroplacental insufficiency.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Renovascular hypertension: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Stenosis or occlusion of the renal artery stimulates the affected kidney to release the enzyme renin, which converts angiotensinogen — a plasma protein — to angiotensin I. As angiotensin I circulates through the lungs and liver, it converts to angiotensin II, which causes peripheral vasoconstriction, increased arterial pressure and aldosterone secretion and, eventually, hypertension.

Atherosclerosis (especially in older males) and fibromuscular diseases of the renal artery wall layers — such as medial fibroplasia and, less commonly, intimal and subadventitial fibroplasia — are the primary causes in 95% of all patients with renovascular hypertension. Other causes include arteritis, anomalies of the renal arteries, embolism, trauma, tumor, and dissecting aneurysm. Less than 5% of patients with high blood pressure display renovascular hypertension; it’s most common in persons younger than age 30 or older than age 50.

PEDIATRIC TIP Fibromuscular dysplasia is the most common cause of renovascular hypertension in children. The surgical cure rate is very high.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulse pressure, widened: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Aortic insufficiency

With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial gallop or ventricular gallop develop. These signs may be accompanied by chest pain; palpitations; pallor; strong, abrupt carotid pulsations; pulsus bisferiens; and signs of heart failure, such as crackles, dyspnea, and jugular vein distention. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis

With this disorder, reduced arterial compliance causes progressive widening of pulse pressure, which becomes permanent without treatment of the underlying disorder. This sign is preceded by moderate hypertension and accompanied by signs of vascular insufficiency, such as claudication, angina, and speech and vision disturbances.

Febrile disorders

Fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder.

Increased intracranial pressure

Widening pulse pressure is an intermediate to late sign of increased ICP. Although decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (Even a gap of only 50 mm Hg can signal a rapid deterioration in the patient’s condition.) Assessment reveals Cushing’s triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Blood pressure increase [Hypertension]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Aldosteronism (primary)

In aldosteronism, elevated diastolic pressure may be accompanied by orthostatic hypotension. Other findings include constipation, muscle weakness, polyuria, polydipsia, and personality changes.

Anemia

Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.

Aortic aneurysm (dissecting)

Initially, aortic aneurysm—a life-threatening disorder—causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure. However, this increase is brief. The body’s ability to compensate fails, resulting in hypotension.

Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.

Atherosclerosis

In atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.

Cushing’s syndrome

Twice as common in females as in males, Cushing’s syndrome causes elevated blood pressure and widened pulse pressure, as well as truncal obesity, moon face, and other cushingoid signs. It’s usually caused by corticosteroid use.

Hypertension

Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.

In malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and a cough with pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.

Increased intracranial pressure (ICP)

Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects heart rate last, causing bradycardia (Cushing’s reflex). Associated signs and symptoms include headache, projectile vomiting, decreased level of consciousness, and fixed or dilated pupils.

Metabolic syndrome

Blood pressure that exceeds 135/85 mm Hg is one of the conditions associated with metabolic syndrome (previously called syndrome X). Other conditions that define this syndrome are obesity, abnormal cholesterol level, and high blood insulin level. Individuals with this combination of risk factors are at a significantly greater risk for developing heart disease, stroke, peripheral vascular disease, and type 2 diabetes. Factors contributing to these conditions include physical inactivity, excessive weight gain, and genetic predisposition. Self-care measures, such as exercising, following a heart-healthy diet, and not smoking, often combined with medical therapy, are essential treatments for this syndrome.

Myocardial infarction (MI)

MI is a life-threatening disorder that may cause high or low blood pressure. The most common symptom is crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.

Pheochromocytoma

Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.

Polycystic kidney disease

Elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys, an enlarged and tender liver, and intermittent gross hematuria.

Preeclampsia and eclampsia

Potentially life threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They’re defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient’s baseline systolic pressure, or an increase of 15 mm Hg above the patient’s baseline diastolic pressure. Other findings include generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea, and possibly seizures (eclampsia).

Renovascular stenosis

Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.

Thyrotoxicosis

Accompanying the elevated systolic pressure associated with thyrotoxicosis—a potentially life-threatening disorder—are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.

Other causes

Drugs

Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.

Herb Alert

Ephedra (ma huang), ginseng, and licorice may cause high blood pressure or an irregular heartbeat. (Note: The FDA has banned the sale of dietary supplements containing ephedra on the grounds that they pose an unreasonable risk of injury or illness.) St. John’s wort can also raise blood pressure, especially when taken with substances that antagonize hypericin, such as amphetamines, cold and hay fever medications, nasal decongestants, pickled foods, beer, coffee, wine, and chocolate.

Treatments

Kidney dialysis and transplantation cause transient elevation of blood pressure.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Hypertension: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Essential hypertension

❑ White coat hypertension

❑ Renal artery stenosis

❑ Drug-induced hypertension

❑ Atherosclerotic vascular noncompliance

❑ Pheochromocytoma

❑ Cushing syndrome

❑ Hyperaldosteronism

❑ Aortic coarctation

❑ Acute renal artery obstruction

❑ Toxemia

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Hypertension: Causes
(Handbook of Diseases)

Hypertension affects 15% to 20% of adults in the United States. If untreated, it carries a high mortality. Before age 55, a higher percentage of men than women have high blood pressure. This changes after age 55. (See Incidence of hypertension.)

Risk factors

Family history, race (most common in blacks), stress, obesity, a high intake of saturated fats or sodium, use of tobacco, sedentary lifestyle, and aging are risk factors for essential hypertension. Insulin resistance has also been implicated in some patients.

Clinical tip  Systolic hypertension poses a risk that’s equal to or greater than diastolic elevations. It’s commonly seen in elderly people and presents a risk for stroke or myocardial infarction (MI).

Secondary hypertension may result from renovascular disease; pheochromocytoma; primary hyperaldosteronism; Cushing’s syndrome; thyroid, pituitary, or parathyroid dysfunction; coarctation of the aorta; pregnancy; neurologic disorders; and use of hormonal contraceptives or other drugs, such as cocaine, epoetin alfa, and cyclosporine.

Blood pressure regulators

Cardiac output and peripheral vascular resistance determine blood pressure. Increased blood volume, cardiac rate, and stroke volume as well as arteriolar vasoconstriction can raise blood pressure. The link to sustained hypertension is unclear. Hypertension may also result from the failure of the following intrinsic regulatory mechanisms:

❑ Renal hypoperfusion causes the release of renin, which is converted by angiotensinogen, a liver enzyme, to angiotensin I. Angiotensin I is converted to angiotensin II, a powerful vasoconstrictor. The resulting vasoconstriction increases afterload.

Angiotensin II stimulates adrenal secretion of aldosterone, which increases sodium reabsorption. Hypertonic-stimulated release of antidiuretic hormone from the pituitary gland follows, increasing water reabsorption, plasma volume, cardiac output, and blood pressure.

❑ Autoregulation changes the diameter of an artery to maintain perfusion despite fluctuations in systemic blood pressure. The intrinsic mechanisms responsible include stress relaxation (vessels gradually dilate when blood pressure rises to reduce peripheral resistance) and capillary fluid shift (plasma moves between vessels and extravascular spaces to maintain intravascular volume).

❑ When the blood pressure drops, baroreceptors in the aortic arch and carotid sinuses decrease their inhibition of the medulla’s vasomotor center, which increases sympathetic stimulation of the heart by norepinephrine. This in turn increases cardiac output by strengthening the contractile force, increasing the heart rate, and augmenting peripheral resistance by vasoconstriction.

Stress can also stimulate the sympathetic nervous system to increase cardiac output and peripheral vascular resistance.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Pulmonary hypertension: Causes
(Handbook of Diseases)

Primary pulmonary hypertension begins as hypertrophy of the small pulmonary arteries. The medial and intimal muscle layers of these vessels thicken, decreasing distensibility and increasing resistance. This disorder then progresses to vascular sclerosis and obliteration of small vessels. Because this form of pulmonary hypertension occurs in association with collagen diseases, it’s thought to result from altered immune mechanisms.

Usually, pulmonary hypertension is secondary to hypoxemia from an underlying disease process, including:

❑ alveolar hypoventilation from chronic obstructive pulmonary disease (most common cause in the United States), sarcoidosis, diffuse interstitial pneumonia, pulmonary metastasis, and certain diseases such as sclero-derma.

These diseases may cause pulmo-nary hypertension through alveolar destruction and increased pulmonary vascular resistance. Other disorders that cause alveolar hypoventilation without lung tissue damage include obesity, kyphoscoliosis, and obstructive sleep apnea.

❑ vascular obstruction from pulmonary embolism, vasculitis, and disorders that cause obstructions of small or large pulmonary veins, such as left atrial myxoma, idiopathic veno-occlusive disease, fibrosing mediastinitis, and mediastinal neoplasm.

❑ primary cardiac disease, which may be congenital or acquired. Congenital defects that cause left-to-right shunting of blood — such as patent ductus arteriosus, or atrial or ventricular septal defect — increase blood flow into the lungs and consequently raise pulmonary vascular pressure.

Acquired cardiac disease, such as rheumatic valvular disease and mitral stenosis, increases pulmonary venous pressure by restricting blood flow returning to the heart.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hypertension, pregnancy-induced: Causes
(Handbook of Diseases)

The cause of PIH is unknown, but it appears to be related to inadequate prenatal care (especially poor nutrition), parity (more prevalent in primigravidas), multiple pregnancies, preexisting diabetes mellitus, and hypertension.

Age is also a factor. Adolescents and primiparas over age 35 are at higher risk for preeclampsia. Other theories postulate a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Pulse pressure, widened: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Aortic insufficiency

With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial or a ventricular gallop develop. These signs may be accompanied by chest pain, palpitations, pallor, pulsus bisferiens, and strong, abrupt carotid pulsations. Other signs of heart failure, such as crackles, dyspnea, and jugular vein distention, may also be present. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis

With arteriosclerosis, reduced arterial compliance causes progressive widening pulse pressure, which becomes permanent without treatment of the underlying disorder. This sign is preceded by moderate hypertension and is accompanied by signs of vascular insufficiency, such as claudication, angina, and speech and vision disturbances.

Febrile disorders

Fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder.

Increased ICP

Widening pulse pressure is an intermediate to late sign of increased ICP. Although a decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (Even a gap of only 50 mm Hg can signal a rapid deterioration in the patient’s condition.) Assessment reveals Cushing’s triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Pulse pressure, widened: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Aortic insufficiency

With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial gallop or ventricular gallop develop. These signs may be accompanied by chest pain; palpitations; pallor; strong, abrupt carotid pulsations; pulsus bisferiens; and signs of heart failure, such as crackles, dyspnea, and jugular vein distention. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis

With arteriosclerosis, pulse pressure progressively widens. This sign is preceded by moderate hypertension and is accompanied by signs of vascular insufficiency, such as claudication, angina, and speech and vision disturbances.

Febrile disorders

Fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder but may include fatigue, chills, malaise, anorexia, tachycardia, tachypnea, and diaphoresis.

Increased intracranial pressure

Widening pulse pressure is an intermediate to late sign of increased ICP. Although decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (Even a gap of only 50 mm Hg can signal a rapid deterioration in the patient’s condition.) Assessment reveals Cushing’s triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Hypertension: Principal Causes of Hypertension
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

  1. Transienthypertension
  2. Sustained hypertension
    1. Birthto one year
      1. Mostcommon
        1. Renalartery thrombosis after umbilical artery catheterization
        2. Coarctation of the aorta
        3. Congenital renal disease
        4. Renal artery stenosis
      2. Less common
        1. Bronchopulmonary dysplasia
        2. Patent ductus arteriosus
        3. Intraventricular hemorrhage
    2. One to ten years
      1. Most common
        1. Renaldisease
        2. Coarctation of the aorta
      2. Less common
        1. Renal artery stenosis
        2. Glucocorticoid excess
        3. Sex hormones
        4. Catecholamine excess
        5. Neuroblastoma
        6. Pheochromocytoma
      3. Mineralocorticoid excess
        1. High aldosteronemineralocorticoid excess
          1. Primary aldosteronism
          2. Glucocorticoid-remediable aldosteronism
          3. Hyperreninemic hyperaldosteronism
        2. Low aldosterone mineralocorticoid excess
          1. 17-Alpha-hydroxylasedeficiency
          2. 11-Beta-hydroxylase deficiency
          3. Apparent mineralocorticoid excess
      4. Hyperthyroidism
      5. Hypercalcemia
      6. Renal tumors
      7. Nervous system disorders
      8. Drugs
      9. Primary or essential hypertension
    3. Eleven years through adolescence
      1. Most common
        1. Renaldisease
        2. Primary or essential hypertension
        3. Less common
          1. All diagnoses listed above

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Pulse pressure, widened: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Aortic insufficiency.With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial or a ventricular gallop develop. These signs may be accompanied by chest pain; palpitations; pallor; strong, abrupt carotid pulsations; pulsus bisferiens; and signs of heart failure, such as crackles, dyspnea, and jugular vein distention. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis.With arteriosclerosis, reduced arterial compliance causes progressive widening of pulse pressure, which becomes permanent without treatment of the underlying disorder. This sign is preceded by moderate hypertension and accompanied by signs of vascular insufficiency, such as claudication and angina.

Febrile disorder.Fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder causing the fever.

Increased ICP.Widening pulse pressure is an intermediate to late sign of increased ICP. Although decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (A gap of 50 mm Hg can signal a rapid deterioration in the patient's condition.) Assessment reveals Cushing's triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Blood pressure, increased [Hypertension]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anemia.Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.

Aortic aneurysm (dissecting).Initially, this life-threatening disorder causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure; however, this increase is brief. The body's ability to compensate fails, resulting in hypotension.

Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.

Atherosclerosis.With atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.

Cushing's syndrome.Cushing's syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It's usually caused by corticosteroid use.

Hypertension.Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.

With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing of pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.

Increased intracranial pressure (ICP).Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects the heart rate last, causing bradycardia (Cushing's reflex). Associated signs and symptoms include headache, projectile vomiting, a decreased level of consciousness, and fixed or dilated pupils.

Metabolic syndrome.Blood pressure that exceeds 135/85 mm Hg is one of the conditions associated with metabolic syndrome (previously called syndrome X). Other conditions that define this syndrome are obesity, abnormal cholesterol level, and high blood insulin level. Individuals with this combination of risk factors are at a significantly greater risk for developing heart disease, stroke, peripheral vascular disease, and type 2 diabetes. Factors contributing to these conditions include physical inactivity, excessive weight gain, and genetic predisposition.

Myocardial infarction (MI).MI is a life-threatening disorder that may cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.

Pheochromocytoma.Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.

Polycystic kidney disease.With polycystic kidney disease, elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys; an enlarged, tender liver; and intermittent gross hematuria.

Preeclampsia and eclampsia.Potentially life-threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They're defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient's baseline systolic pressure, or an increase of 15 mm Hg above the patient's baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea and, possibly, seizures.

Renovascular stenosis.Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.

Thyrotoxicosis.Accompanying the elevated systolic pressure associated with thyrotoxicosis, a potentially life-threatening disorder, are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, a fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.

Other causes

Drugs.Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.

Treatments.Kidney dialysis and transplantation cause transient elevated blood pressure.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Pulmonary Hypertension: Pulmonary Hypertension - pathophysiology
(The 5-Minute Pediatric Consult)

Structural alterations in pulmonary vessel architecture (remodeling)

  • Smooth muscle hypertrophy
  • Extension of blood vessel’s smooth muscle into smaller vessels
  • Inflammation

Pulmonary Hypertension - etiology

  • Hypoxemia-induced pulmonary hypertension
  • Chronic lung disease
    • Cystic fibrosis
    • Bronchopulmonary dysplasia
    • Interstitial lung disease
  • Upper airway obstruction:
    • Tonsillar and/or adenoid hypertrophy
    • Obesity
  • Hypoventilation:
    • Neurologically mediated process
    • Secondary to muscular weakness
  • High pulmonary blood flow secondary to left-to-right shunting (seen in congenital heart disease):
    • Patent ductus arteriosus
    • Atrial septal defect
    • Ventricular septal defect
  • Left-sided cardiac disorders that increase pulmonary venous pressure:
    • Left ventricular failure
    • Mitral valve stenosis
    • Obstructed anomalous pulmonary veins
  • Occlusion of pulmonary vessels:
    • Sickle cell disease
    • Veno-occlusive disease
    • Thromboembolism
  • Pulmonary vasculitis:
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • Scleroderma
  • Persistent pulmonary hypertension of the newborn
  • Idiopathic cases (primary pulmonary hypertension)

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008


 » Next page: Risk Factors for Primary pulmonary hypertension

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