Signs You Might Have Pulmonary Hypertension

What is pulmonary hypertension and how does it affect the lungs and heart?

Pulmonary hypertension occurs when the tiny arteries in your lungs, called pulmonary arteries, become narrowed, blocked, or damaged. This makes it harder for blood to flow through the lungs, raising pressure within these vessels. Normal pulmonary artery pressure at rest typically ranges from 8-20 mmHg (millimeters of mercury). In pulmonary hypertension, these pressures exceed 25 mmHg.

This increased pressure creates a domino effect throughout the cardiopulmonary system. The right ventricle of your heart, which pumps blood into the pulmonary arteries, must work significantly harder against this resistance. Over time, this extra workload causes the right ventricle to enlarge and weaken. As the heart’s pumping ability deteriorates, less oxygen reaches the body’s tissues, creating a cascade of symptoms that worsen as the condition progresses.

Pulmonary hypertension is classified into five groups based on its underlying causes, ranging from conditions you’re born with (congenital heart defects) to those acquired through other diseases (such as left heart disease, lung disease, blood clots, or other conditions). In some cases, the cause remains unknown, a form called idiopathic pulmonary arterial hypertension.

How does shortness of breath during daily activities relate to pulmonary hypertension?

Shortness of breath (dyspnea) is often the earliest and most common symptom of pulmonary hypertension. Initially, you might notice breathlessness only during physical exertion like climbing stairs or walking uphill. What makes pulmonary hypertension particularly insidious is that this symptom typically develops gradually over months or even years, making it easy to dismiss as simply being “out of shape” or a natural part of aging.

As the condition progresses, this breathlessness begins to intrude on increasingly lighter activities. Tasks that once seemed effortless—like showering, getting dressed, or preparing meals—may leave you struggling to catch your breath. Eventually, some patients experience shortness of breath even when resting.

The mechanism behind this symptom lies in the heart-lung relationship. When pulmonary arteries are constricted, the right side of the heart cannot efficiently deliver blood to the lungs for oxygenation. This reduced oxygen exchange means less oxygen-rich blood circulates throughout your body, leading to that persistent feeling of breathlessness. The severity of this symptom often correlates with disease progression, making it an important indicator for healthcare providers to monitor.

Why is fatigue or dizziness a common symptom in this condition?

Fatigue and dizziness in pulmonary hypertension stem directly from decreased oxygen delivery throughout the body. When your heart cannot efficiently pump blood through constricted pulmonary vessels, less oxygenated blood returns to the left side of your heart for distribution to your tissues and organs. This oxygen deficit forces your body to work harder for basic functions, resulting in profound fatigue that doesn’t improve with rest.

Many patients describe this fatigue as overwhelming and unlike normal tiredness—it can make even minor activities feel exhausting and may significantly impact quality of life and ability to work. The fatigue may be accompanied by weakness or a general feeling of malaise.

Dizziness and fainting (syncope) occur when insufficient oxygen reaches the brain. These symptoms typically manifest during physical exertion when oxygen demands increase but the compromised cardiopulmonary system cannot meet them. Episodes of lightheadedness, especially during activity, should never be ignored as they can indicate advanced disease and signal a high risk of fainting, which could lead to injury from falls. In severe cases, these symptoms may appear even at rest, indicating critically reduced cardiac output.

How can chest pain or a racing heartbeat signal elevated pulmonary pressure?

Chest pain in pulmonary hypertension often differs from the crushing chest pain typical of coronary artery disease. Patients frequently describe it as a dull, pressing discomfort or sometimes a sharp pain, usually worsening during physical activity. This pain occurs because the overworked right ventricle becomes oxygen-deprived when struggling against high pulmonary pressures.

A racing heartbeat (tachycardia) develops as a compensatory mechanism. When each heartbeat delivers less oxygen than needed (due to increased pulmonary resistance), the heart naturally speeds up to deliver more oxygen over time. Many patients report palpitations—sensations of heart fluttering, pounding, or irregular beating. These palpitations may be particularly noticeable during physical activity but can occur at rest in advanced disease.

In some cases, angina-like chest pain may develop during exertion and resolve with rest. This symptom is particularly concerning as it indicates the heart muscle itself is suffering from oxygen deprivation. If you experience unexplained chest pain along with shortness of breath, especially if these symptoms are progressive, seeking prompt medical evaluation is crucial, as these could indicate worsening pulmonary hypertension.

What role does swelling in the legs or abdomen play in identifying pulmonary hypertension?

Swelling (edema) in the ankles, feet, legs, and eventually the abdomen represents a later-stage symptom of pulmonary hypertension. This swelling occurs due to right-sided heart failure, a condition called cor pulmonale that develops as pulmonary hypertension progresses. When the right ventricle cannot efficiently pump blood forward through the lungs, blood backs up in the venous system, increasing pressure in the veins.

This elevated venous pressure forces fluid from the bloodstream into surrounding tissues, causing visible swelling. Many patients first notice that their shoes feel tight, especially by the end of the day. The swelling typically begins in the ankles and may progress upward to include the legs and eventually the abdomen (ascites). In advanced cases, this fluid retention can cause significant weight gain over relatively short periods.

Another telltale sign is that the swelling often improves overnight when lying down, as gravity no longer concentrates fluid in the lower extremities, but returns upon standing or sitting for extended periods. Unlike swelling from other causes like prolonged standing or salt consumption, edema from pulmonary hypertension tends to be persistent and progressive without appropriate treatment.

Abdominal swelling can also indicate liver congestion due to backed-up blood flow, resulting in uncomfortable fullness or pain in the upper right abdomen. Some patients may notice increasing abdominal girth requiring looser clothing, particularly around the waist.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.