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- [Voiceover] So now going forward, I want to talk about both some of the symptoms in pulmonary hypertension and also the causes. To keep it separate, let's use a color code system. So orange is gonna be for symptoms. And we'll talk about symptoms in all the different parts of the circuit. And then purple is when we talk about causes. Because it can be caused at different parts of the body as well. Alright, starting with the lungs. Symptoms, right off the bat, we're gonna be short of breath. So short of breath. Because when we don't have enough adequate lung supply, then the lungs themselves are stressed because they need blood too. But also the air exchange that we care about here is not happening well. And with that we get exercise intolerance because any time we exercise, the heart pumps double time into the lungs to get more blood through faster. And if our lungs are not working well to receive that blood, then when we exercise, it's hard to oxygenate, and we get tired more quickly. And then the tissues themselves of the lungs, because the blood vessels are, for some reason, narrowing all the time and we're pushing a lot of blood through it day in and day out, we can get scarring. And this is structural damage to the lungs. Because pulmonary hypertension might be temporary or it might be chronic. And chronically we will get scarring. And then we might cough. The tissue in the lungs that are not adequately being provided with blood, the airways can spasm as a result. So all of these are pretty intuitive. Just things that can go wrong with the lungs themselves, symptoms-wise. But if we take a look at this whole diagram, look at how the right side of the heart feeds blood to the lungs. So if we have a bottleneck here, squeezing down it's hard to get into the lungs, then we back up into the right heart and we back up eventually into this blue person. To be more specific and scientific here, let's call this our venous system. So veins are the vessels that return blood to the heart. And this side we have arteries, which carry blood away from the heart. Arteries. Before we get to the veins though, let's look at the right heart to begin with. So in the right side of the heart, we might get right ventricular, right ventricular hypertrophy. So hypertrophy is a word that describes like a muscle that's used too much, overused, and it gets bigger. Because it's the right heart's job to pump blood to the lungs. Since we increased its workload, then it's going to get bigger. Because the heart is just a muscle. So the right side might get bigger. You might think a stronger heart is a good thing. But right ventricular hypertrophy is not good because this chamber can get dilated bigger than it's supposed to. It's gonna malfunction if it's thicker than it's supposed to. So right ventricular hypertrophy is not good, and it can lead to heart failure. So with that, we can get right heart failure. Right heart failure just from all the backup and all the increased workload if the pulmonary hypertension is chronic. So we get right heart failure, which means it's not pumping well, it's not doing its job. Then this backup goes further back into the venous system. So now the veins in our body are not draining well. So we might get swelling. Just pooling of blood in the veins because it's not moving forward well. So this swelling we might think of as in our hands or feet and muscles, but there are other veins in the body that feed into this system as well. In the liver, for example, we can have portal hypertension. This is when the gut and the liver drains into the venous system. So portal, I'm going to write HTN for hypertension. It's an abbreviation. And this can be serious thing. It can cause the liver to malfunction. Then we're really in trouble. It can back up into the spleen, and the gut is all connected. So these are symptoms of right heart failure, which can come from pulmonary hypertension. And any of these can be very serious, especially on a chronic basis. Alright so now let's come on the artery side and see what happens going forward. See here the rest of the body here is lacking in blood, so going forward we simply don't get enough blood out into the body, enough oxygen in the blood. So we're going to have problems of undersupply. This person might get dizzy. He might get lightheaded and faint a lot. Fainting. And again they might have exercise intolerance because their body is not being provided with nutrients and oxygen. Alright so these are some of the more important, so these are just a quick sample of some of our symptoms. Now let's go to causes. Now if we think of the simplest solution being the best solution, then you can imagine that a lot of the problems, the causes come from the lungs themselves. So basically any lung disease could cause this, especially chronic ones. Any lung disease. So what can we think of? Things like emphysema. This is often linked to smoking. We'll always say they stop smoking because this can lead to all sorts of problems including hypertension in the lungs. We can have drug related, alcohol related intoxication. We can have newborns or premature babies who are born too early, and their lungs haven't developed properly and don't have the surfactant to support it. So babies in general actually have very high pulmonary resistance when they're born, but it's supposed to lessen as they get a little older. But in premature babies, they can have lung damage, and their pulmonary hypertension can be chronic and hard to resolve. So keep going with the lung disease, we can have all sorts of systemic, or we can have diseases that affect the whole body. Things like HIV, cancer, diabetes, all these things can come back and affect lungs. So any lung disease really could cause hypertension. Now if we look beyond the lungs, what else can cause this? So remember when we talked about backup earlier? So if we're talking about causes now, then left heart failure is going to be one of the causes. Left heart failure, which in itself can be caused by so many other things. But if the left ventricle, or the left atrium I guess, are not functioning well and not pushing the blood forward, then the backup into the lungs will cause pulmonary hypertension. So like we said before, it's all related. So left heart failure leading to pulmonary hypertension. On the venous side, I'm not going to list the long list, but think of the things that can make your blood thicker, so more coagulable. Or diseases that disrupt the venous flow of blood into the heart, then eventually it'll affect the lungs as well. So the pattern we're seeing is that, since the lungs are such an important central organ, then almost anything under the sun can lead to pulmonary hypertension, and the symptoms we have can also be anywhere.