Pulmonary Insufficiency Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Pulmonary insufficiency is also known as pulmonary regurgitation. This term is used to describe a condition in which the pulmonary valve ‘leaks’, resulting in the backflow of blood from the pulmonary artery to the right ventricle.
Under normal circumstances, there should be a flow of blood that contains little oxygen from the right ventricle to the lungs via the pulmonary artery.
Symptoms
Often, pulmonary insufficiency is asymptomatic (no symptoms). In some patients, there will be symptoms associated with enlargement of the right ventricle of the heart and heart failure.
Things that people with pulmonary insufficiency may complain about include:
- Dyspnea on exertion: shortness of breath that occurs during activity
- Easily tired
- Dizzy
- peripheral edema
- Chest pain
- Palpitations or pounding
- Faint
Reason
The most common causes of pulmonary insufficiency are the presence of pulmonary hypertension and congenital heart disease (usually tetralogy of Fallot ). Secondary pulmonary hypertension, which occurs in patients with normal pulmonary valves but who have severe pulmonary arterial hypertension or dilatation of the pulmonary arteries, most commonly causes regurgitation or pulmonary insufficiency.
In cases of congenital heart disease, the condition of Tetralogy of Fallot, especially in the absence of a pulmonary valve or after surgery to repair Tetralogy of Fallot, is often associated with the appearance of pulmonary insufficiency.
Apart from the two common causes above, pulmonary regurgitation can also be caused by several conditions. For example, infective endocarditis, idiopathic pulmonary artery dilatation, and congenital heart valve disease. However, these causes are less common. Furthermore, very rare causes of pulmonary insufficiency include carcinoid syndrome, rheumatic fever, and trauma from catheterization.
Diagnosis
To determine the diagnosis of pulmonary insufficiency, it is necessary to carry out a thorough evaluation. This comprehensive evaluation is carried out through:
- Detailed anamnesis or medical interview to find a medical history, signs and symptoms that are felt.
- Physical examination: complete examination of the heart (especially the presence of murmurs in early diastole), increased jugular venous pressure, often found an enlarged liver.
- Supporting examinations, such as:
- In general, an echocardiographic examination of the heart is required
- EKG (electrocardiography) examination may show right ventricular hypertrophy
- Chest X-ray examination may show enlargement of the right ventricle
- Cardiac MRI ( Magnetic Resonance Imaging ) may be considered
Treatment
In general, rare cases of pulmonary insufficiency are so severe that they require special treatment. Normally, the right ventricle is quite adaptable to the increased pressure caused by the volume overload caused by backflow of blood into the right ventricle.
Therefore, the treatment of pulmonary regurgitation is generally focused on treating the cause of pulmonary insufficiency. This is mainly done to prevent the occurrence of right heart failure which can exacerbate clinical conditions.
In severe cases, surgery to replace the pulmonary valve may be recommended, but this treatment is rarely done. Indications for surgery are:
- Symptomatic and severe pulmonary insufficiency
- Asymptomatic but severe pulmonary insufficiency with severe right ventricular dilatation and/or dysfunction or symptomatic arrhythmias of the ventricles or atria
- Dysfunction on cardiac MRI with end-diastolic volume of the right ventricle above 150 ml/m 2, end-systolic volume above 80 mL/m 2 and ejection fraction below 47%
- Severe pulmonary insufficiency and progressive regurgitation of the tricuspid valve
In patients with pulmonary insufficiency, there are no special dietary restrictions. However, in patients with symptoms of heart failure, salt consumption should be limited. Whereas in patients with pulmonary regurgitation, activity restrictions are also not needed.
The important thing to do is to monitor the course of the disease. This control should be done every year, or according to the doctor’s advice. Generally, this condition will be monitored using echocardiography.