Pulmonary Heart Disease: Causes, Symptoms, and Treatment
Pulmonary heart disease, often linked to lung conditions like COPD and pulmonary hypertension, strains the heart’s right ventricle, leading to heart failure. Early diagnosis, targeted treatment, and lifestyle changes can improve outcomes and manage symptoms effectively.
Written by Dr Sonia Bhatt
Last updated on 3rd Jul, 2025
Pulmonary heart disease is a serious medical condition of the heart that is caused by the lungs. It is also known as cor pulmonale and can cause disruptions in the heart’s functioning. The main causes of this disease include pulmonary hypertension. In simple words, this happens when the arteries of the lungs (known as pulmonary arteries) experience high blood pressure (i.e., hypertension). This puts strain on the right side of the heart. The long-term impact of pulmonary heart disease is that it may increase the pressure on the heart’s right ventricle. When this happens, the heart loses its ability to pump blood, which ultimately leads to heart failure.
Importance of Understanding Pulmonary Heart Disease
The reason that pulmonary heart disease has become more common today is due to the rise of chronic lung diseases. For example, increasing occurrences of chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, etc., have made pulmonary heart disease a more common disease than ever before. Those suffering from this disease experience a deterioration in their quality of life. The high mortality rates from pulmonary heart disease make it an important healthcare issue that needs to be addressed.
Causes of Pulmonary Heart Disease
There are several underlying causes of pulmonary heart disease. While these conditions may not necessarily always lead to pulmonary heart disease, they do increase a person’s risk of developing it.
Chronic Obstructive Pulmonary Disease (COPD): This is one of the most common underlying causes of pulmonary heart disease. COPD is a chronic infection of the lungs that blocks the airways and leads to low blood-oxygen saturation (hypoxemia). This, in turn, constricts the pulmonary arteries. If untreated, COPD can easily develop into pulmonary heart disease because pressurised arteries strain the right ventricle of the heart.
Pulmonary Arterial Hypertension (PAH): This underlying cause of pulmonary heart disease happens when the pulmonary arterial walls get narrower and thicker simultaneously. This increases resistance to blood flowing within them. PAH may be caused due to genetic reasons (heritable) or may even occur without cause (idiopathic). However, the occurrence of PAH increases the risks of individuals developing pulmonary heart disease.
Other Pulmonary Conditions: Besides COPD and PAH, a host of other diseases can lead to the onset of pulmonary heart disease. For example, pulmonary fibrosis, chronic thromboembolic pulmonary hypertension (CTEPH), or even sleep apnea can gradually lead to pulmonary heart disease if untreated.
Pathophysiology of Pulmonary Heart Disease
To better understand how pulmonary heart disease develops, it is necessary to learn the functional changes in the body that lead to its development (i.e., its pathophysiology).
How Lung Disorders Affect Heart Function: An important part of the pathophysiology of pulmonary heart disease is understanding how lung disorders affect the functioning of the heart. Disorders of the lung reduce blood-oxygen levels, which in turn leads to the constriction of the pulmonary arteries (hypoxic pulmonary vasoconstriction).
Mechanisms Leading to Heart Dysfunction: When persistent pressure on the pulmonary arteries thickens the right ventricle (chronic pulmonary hypertension). As a result, the heart struggles to pump blood to the rest of the body. Over time, the right ventricle becomes dilated, and this ultimately leads to heart failure.
Risk Factors for Developing Pulmonary Heart Disease
Although, in most cases, lung disorders usually lead to pulmonary heart disease, there are other risk factors involved.
Smoking: Heavy smokers are at a higher risk of developing lung diseases due to the damage incurred by their lungs over time.
Pollutants: Long-term and regular exposure to pollutants or asbestos has been found to increase the risk of developing lung diseases like COPD.
Geographic Location: Those who live at higher altitudes where the atmosphere lacks oxygen may also experience lower blood-oxygen saturation, leading to lung disorders.
Family History: If there is a family history of pulmonary hypertension, the risk of developing lung disorders and, subsequently, pulmonary heart disease increases.
Genetic Conditions: Some individuals may also have genetic conditions that can increase their risk of developing pulmonary heart disease, such as congenital heart defects and Eisenmenger syndrome, among others.
Symptoms and Early Signs
The signs and symptoms of pulmonary heart disease may manifest early on. If ignored and left untreated, it could lead to eventual heart failure. Some of these symptoms include:
1.Respiratory Symptoms
Breathlessness (dyspnea), particularly during physical activity.
Persistent fatigue
Chest discomfort
Chronic cough
2.Cardiac Symptoms
Swelling in the legs (oedema)
Chest pain
Palpitations
Cyanosis (a bluish skin discolouration due to poor oxygenation).
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Diagnostic Procedures
There are several diagnostic procedures to identify the onset and progress of pulmonary heart disease. When conducted early on, the chances of recovery may increase.
Imaging techniques such as echocardiography help doctors visualise the right ventricle to evaluate the pressure on the pulmonary arteries.
Other imaging techniques like chest X-rays and CT scans can also help doctors assess the overall condition of the lungs and detect conditions such as pulmonary fibrosis and embolism, which are precursors to pulmonary heart disease.
Doctors may also conduct blood tests that measure biomarkers like brain natriuretic peptide (BNP) and understand the strain on the heart.
The most important diagnostic test to confirm pulmonary heart disease is the right heart catheterisation technique that indicates pulmonary hypertension accurately.
Treatment Options
Upon accurate diagnosis, pulmonary heart disease is treatable and curable. This can be done either through pharmacological treatments or surgical and non-surgical methods.
1.Pharmacological Treatments
Doctors usually prescribe pulmonary vasodilators like endothelin receptor antagonists.
In some cases, doctors may also prescribe phosphodiesterase inhibitors.
On the other hand, prostacyclin analogues have also been known to work well.
Some doctors also prescribe a combination of diuretics to manage fluid retention and oxygen therapy.
2.Surgical and Non-Surgical Interventions
In severe cases, surgical interventions such as lung transplantation or atrial septostomy may be considered.
Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary thromboendarterectomy, a procedure to remove blood clots from the pulmonary arteries.
Lifestyle Modifications for Managing the Condition
Some lifestyle modifications may be necessary to manage pulmonary heart disease effectively. For example, consuming a diet rich in fruits, vegetables, and whole grains can be helpful. Additionally, regular exercise is always good for improving cardiovascular health.
Prognosis and Life Expectancy
The prognosis of pulmonary heart disease often depends on the underlying cause, the severity of pulmonary hypertension, and the timeliness of treatment. Conditions such as idiopathic pulmonary arterial hypertension often carry a poorer prognosis compared to secondary forms of the disease.
However, close monitoring, timely and accurate treatment, and managing comorbidities can help improve the prognosis of pulmonary heart disease.
Conclusion
If left untreated, pulmonary heart disease can become a severe heart condition that will eventually lead to total heart failure. Proper treatment can be helpful with timely diagnosis of the early signs. With the help of advanced imaging techniques and molecular diagnostics, pulmonary heart disease can be detected in its nascent stages. This can help a doctor advise on how to manage this disease.
The future holds hope for a more advanced diagnosis of this disease and a better prognosis. Ongoing research into molecular mechanisms of pulmonary hypertension can help develop more targeted therapies that can prevent pulmonary heart disease.
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