Pulmonary hypertension: an invisible killer that cannot be ignored

Author: Huang Yanhong Duan Yuechu

In the vast system of cardiovascular diseases, pulmonary hypertension is a relatively hidden but very serious disease. It is like an "invisible killer" lurking in the body. The early symptoms are not obvious and are easily ignored. When the disease worsens, it will gradually reveal its hideous face. Today, let us learn more about pulmonary hypertension, including its symptoms, prevention and treatment methods, and commonly used drugs, to add a guarantee to protect health.

1. Definition and Overview of Pulmonary Hypertension

Pulmonary hypertension (PH) is a disease characterized by progressive increase in pulmonary vascular resistance and elevated pulmonary artery pressure, which can eventually lead to right heart failure or even death. Under normal circumstances, the pressure in the pulmonary artery is relatively low. When various reasons cause abnormal increase in pulmonary artery pressure, a series of pathological and physiological changes will be triggered.

1. Normal pulmonary artery physiology

The pulmonary artery is responsible for transporting low-oxygen blood from the right ventricle of the heart to the lungs, where gas exchange takes place, and the blood is oxygenated before returning to the left atrium of the heart. The structure and function of the pulmonary artery enable it to adapt to this low-pressure, high-flow blood circulation pattern. Normal pulmonary artery pressure at rest is about 18-25 mmHg systolic pressure, about 6-10 mmHg diastolic pressure, and an average pressure of 12-16 mmHg.

2. Diagnostic criteria for pulmonary hypertension

At present, the diagnosis of pulmonary hypertension is mainly based on the "gold standard" of right cardiac catheterization in clinical practice. When the mean pulmonary artery pressure (mPAP) measured by the right cardiac catheter is ≥ 25 mmHg at rest, pulmonary hypertension can be diagnosed. However, right cardiac catheterization is an invasive examination. In actual clinical work, some non-invasive examination methods such as echocardiography are also combined for preliminary screening and evaluation. If the echocardiogram indicates an increase in pulmonary artery systolic pressure (usually > 30 mmHg), further examination is required to determine whether pulmonary hypertension exists.

3. Classification of pulmonary hypertension

Pulmonary hypertension is not a single disease, but a clinical syndrome with multiple causes and pathogenesis. Based on the different causes, pathophysiology and treatment strategies, it is currently divided into five categories:

1. Arterial pulmonary hypertension (PAH): including idiopathic pulmonary hypertension, hereditary pulmonary hypertension, pulmonary hypertension caused by related factors (such as connective tissue disease, congenital heart disease, drugs and poisons, etc.). This type of pulmonary hypertension is characterized by lesions in the pulmonary arterioles themselves, leading to vasoconstriction, remodeling and occlusion, which in turn causes increased pulmonary artery pressure.

2. Pulmonary hypertension caused by left heart disease: such as left heart valvular disease (mitral stenosis, aortic regurgitation, etc.), left heart systolic or diastolic dysfunction, etc. Due to abnormal left heart function, the pulmonary venous pressure increases, and then the reverse conduction causes the pulmonary artery pressure to increase.

3. Pulmonary hypertension caused by lung disease and/or hypoxia: common in chronic obstructive pulmonary disease (COPD), interstitial lung disease, sleep apnea hypopnea syndrome, etc. Lung disease leads to pulmonary ventilation and/or gas exchange dysfunction, causing hypoxia, which in turn leads to pulmonary vasoconstriction and remodeling, and increased pulmonary artery pressure.

4. Chronic thromboembolic pulmonary hypertension (CTEPH): It is caused by the formation and organization of thrombi in the pulmonary arteries, which leads to stenosis or occlusion of the pulmonary artery lumen and increased pulmonary vascular resistance, thus causing pulmonary hypertension.

5. Pulmonary hypertension caused by other unknown multifactorial mechanisms: including pulmonary hypertension caused by blood system diseases (such as chronic hemolytic anemia), systemic diseases (such as sarcoidosis, Langerhans cell histiocytosis), metabolic diseases (such as glycogen storage disease), etc.

2. Symptoms of pulmonary hypertension

1. Early latent

In the early stages of pulmonary hypertension, the body may not send obvious signals. Many patients often do not realize that they are ill and still maintain a normal pace of life. This is because the increase in pulmonary artery pressure is still relatively mild at this time, and the body's compensatory mechanism can temporarily maintain normal physiological functions. For example, the heart will maintain cardiac output by increasing myocardial contractility and heart rate, and the pulmonary blood vessels will also alleviate the impact of increased pressure through some adaptive changes.

However, this hidden nature also makes it easy for the disease to be delayed in diagnosis. Patients may only feel mild discomfort occasionally, such as a little shortness of breath or fatigue after activities, but they often attribute these symptoms to factors such as physical fatigue or aging, and ignore the potential risks of the disease. Once the disease progresses to a certain extent, the difficulty of treatment will be greatly increased, and the patient's prognosis will be seriously affected.

2. Dyspnea after activity

As the disease progresses, dyspnea after activity becomes one of the most common symptoms of pulmonary hypertension. Our heart is like a powerful "pump" responsible for transporting blood to all parts of the body. When the pressure in the pulmonary artery increases, the heart needs to work harder to pump blood into the pulmonary artery. During activity, the body's demand for oxygen increases significantly, and the burden on the heart and lungs increases accordingly.

At this point, the patient will obviously feel the labored breathing, just like when climbing a steep mountain, each breath becomes heavy and difficult. For example, after climbing a few flights of stairs, walking a few hundred meters fast, or doing some simple housework, the patient will experience obvious shortness of breath, and will need to stop and rest for a long time to relieve it. Moreover, as the disease worsens, the patient may also experience shortness of breath during milder activities or even at rest.

The mechanism of dyspnea is mainly related to the following factors: First, pulmonary hypertension leads to increased pulmonary vascular resistance. The right ventricle needs to overcome greater pressure to pump blood into the lungs, which gradually impairs the right ventricular function and reduces cardiac output, leading to insufficient pulmonary blood perfusion and gas exchange disorders, causing hypoxia and carbon dioxide retention, stimulating the respiratory center, and producing a feeling of dyspnea. Second, pulmonary hypertension may also cause pulmonary interstitial edema, further affecting gas exchange and aggravating dyspnea.

3. Fatigue and weakness

In addition to dyspnea, fatigue and weakness are also common symptoms in patients with pulmonary hypertension. As the heart burden increases, the body's blood circulation is affected, and oxygen and nutrients cannot be effectively delivered to various tissues and organs. This is like a car, although the engine is working hard, it cannot exert normal power due to insufficient fuel supply.

Patients often feel tired and have difficulty regaining their energy even after adequate rest. They feel as if their whole body is bound by an invisible yoke and have no strength to carry out normal activities. For example, patients may feel overwhelmed and unable to concentrate in their daily work, or find it very strenuous to carry out simple activities such as dressing and washing.

The main causes of fatigue and weakness are reduced cardiac output, which leads to insufficient perfusion of tissues and organs, cellular hypoxia, and energy metabolism disorders. In addition, patients with pulmonary hypertension often have respiratory dysfunction, increased breathing work, and more energy consumption, further aggravating fatigue. At the same time, this fatigue and weakness will not only affect the daily life of patients, but also have a certain negative impact on their mental health, leading to emotional problems such as anxiety and depression.

4. Chest pain

Patients with pulmonary hypertension may also experience chest pain. This is because as the pulmonary artery pressure continues to rise, the load on the right heart becomes heavier, and the myocardium becomes ischemic and hypoxic. Just like our muscles feel sore when they are overworked, the myocardium will also feel pain when it is ischemic and hypoxic.

The degree and duration of chest pain vary from person to person. Some patients may only feel a brief stabbing pain occasionally, while others may experience continuous dull pain, even when resting. Chest pain is usually located behind the sternum or in front of the heart, and may also radiate to the left shoulder, inner left arm, neck, jaw, etc. This pain not only causes physical pain to patients, but also makes them feel fearful and uneasy, worrying that their condition will suddenly worsen.

The mechanism of chest pain is mainly related to right ventricular myocardial ischemia. Pulmonary hypertension leads to increased right ventricular afterload, myocardial hypertrophy, and increased myocardial oxygen consumption. At the same time, due to increased pulmonary artery pressure, coronary artery perfusion pressure decreases, myocardial blood supply decreases, leading to myocardial ischemia and hypoxia, causing chest pain. In addition, pulmonary hypertension may also cause pulmonary artery dilation, stimulating the surrounding nerve endings, which can also cause chest pain.

5. Syncope

Some patients with pulmonary hypertension may experience syncope. When pulmonary hypertension develops to a serious stage, the heart's output will drop significantly, leading to insufficient blood supply to the brain. The brain is the "command center" of the human body and is very sensitive to the supply of blood and oxygen. Once the brain is insufficiently supplied with blood, symptoms such as dizziness and blacking out will occur, and in severe cases, people may even suddenly faint.

Syncope often occurs suddenly without any warning, which poses a great safety hazard to the patient's life. For example, when walking, standing or doing other daily activities, the patient may suddenly lose consciousness and fall to the ground, causing physical damage. The mechanism of syncope mainly includes the following aspects: First, due to pulmonary hypertension, the right ventricular outflow tract obstruction occurs, and the cardiac output decreases sharply, causing insufficient cerebral perfusion; second, when the patient is active, the peripheral blood vessels dilate, and the heart cannot increase the cardiac output accordingly, resulting in a drop in blood pressure and insufficient blood supply to the brain; third, patients with pulmonary hypertension may have arrhythmias, such as tachycardia or bradycardia, which will also affect the heart's pumping function, resulting in insufficient blood supply to the brain and causing syncope.

6. Hemoptysis

Some patients with pulmonary hypertension may also experience hemoptysis. This is because the pulmonary artery pressure is too high, causing the blood vessels in the lungs to rupture and bleed. The blood will be coughed out of the body through the respiratory tract, manifesting as blood in the sputum or coughing up blood.

The occurrence of hemoptysis will not only make the patient panic, but may also cause airway obstruction, leading to worsening breathing difficulties and even life-threatening. The mechanism of hemoptysis is mainly due to pulmonary hypertension causing the pulmonary blood vessel walls to thin and expand, forming aneurysmal changes, and these blood vessels are prone to rupture and bleed. In addition, pulmonary hypertension may also cause increased pulmonary venous pressure, leading to bronchial vein rupture and bleeding. In some cases, the patient may suddenly increase the pressure in the lungs due to severe coughing and other reasons, which may also cause these fragile blood vessels to rupture and bleed.

7. Other symptoms

In addition to the typical symptoms mentioned above, patients with pulmonary hypertension may also experience some other symptoms. For example, due to right heart failure leading to systemic congestion, patients may experience edema, which is most common in the lower limbs and can spread to the whole body in severe cases. Digestive system symptoms such as abdominal distension and loss of appetite may also occur, which are caused by gastrointestinal congestion. Some patients may also experience hoarseness, which is caused by the compression of the recurrent laryngeal nerve by the expansion of the pulmonary artery.

3. Prevention and treatment of pulmonary hypertension

1. Preventive measures

1. Actively treat the underlying disease: Many diseases may lead to the occurrence of pulmonary hypertension, such as congenital heart disease, chronic obstructive pulmonary disease, connective tissue disease, etc. Therefore, for patients with these underlying diseases, active treatment should be carried out to control the development of the disease, thereby reducing the risk of pulmonary hypertension.

Patients with congenital heart disease should undergo timely surgical treatment according to their condition to repair structural abnormalities of the heart. Repair surgery such as atrial septal defect, ventricular septal defect, and patent ductus arteriosus can effectively improve cardiac hemodynamics and reduce the occurrence of pulmonary hypertension.

Patients with chronic obstructive pulmonary disease should adhere to standardized drug treatment, such as the use of bronchodilators (salbutamol, ipratropium bromide, etc.), glucocorticoids (budesonide, etc.), etc., to improve lung function, reduce lung inflammation, delay disease progression, and reduce the risk of pulmonary hypertension.

Patients with connective tissue diseases (such as systemic lupus erythematosus, rheumatoid arthritis, etc.) need long-term use of immunosuppressants (cyclophosphamide, methotrexate, etc.) and glucocorticoids and other drugs for treatment to control disease activity and prevent the occurrence of pulmonary hypertension.

2. Avoid risk factors: Try to avoid exposure to risk factors that may induce pulmonary hypertension, such as long-term heavy smoking, exposure to toxic and harmful gases, and taking certain medications that may cause pulmonary hypertension.

Smoking can damage the endothelial cells of the lung blood vessels, leading to vasoconstriction and inflammatory response, increasing the risk of pulmonary hypertension. Therefore, quitting smoking is one of the important measures to prevent pulmonary hypertension.

Long-term exposure to toxic and harmful gases, such as asbestos, coal dust, and chemical solvents, may also damage the blood vessels in the lungs and increase the risk of disease. People who are exposed to these harmful substances at work should strengthen protective measures, such as wearing protective masks and improving ventilation in the working environment.

Certain weight loss drugs, appetite suppressants (such as fenfluramine, dexfenfluramine, etc.), chemotherapy drugs (such as bleomycin, mitomycin, etc.), etc. may be related to the occurrence of pulmonary hypertension. When using these drugs, you should strictly follow the doctor's advice, closely observe the body's reaction, and avoid unnecessary medication.

3. Regular physical examinations: For high-risk groups with a family history of pulmonary hypertension or related underlying diseases, regular physical examinations are very important. Through physical examinations, signs of pulmonary hypertension can be detected early, and intervention measures can be taken in time to delay the progression of the disease.

Physical examination items may include electrocardiogram, cardiac ultrasound, chest X-ray, pulmonary function test, etc. Electrocardiogram can detect the electrical activity of the heart and find out whether there are abnormalities such as arrhythmia and myocardial hypertrophy; cardiac ultrasound can visually observe the structure and function of the heart, measure pulmonary artery pressure, and evaluate right heart function; chest X-ray can understand the morphology and structure of the lungs and find clues to lung diseases; pulmonary function test helps to evaluate the ventilation and gas exchange function of the lungs.

For high-risk groups, it is recommended to have a comprehensive physical examination once a year. If any abnormalities are found, further examinations should be conducted in a timely manner, such as right heart catheterization examination to confirm the diagnosis.

2. Treatment Methods

1. Drug therapy: Drug therapy is one of the main treatments for pulmonary hypertension, aiming to reduce pulmonary artery pressure, improve heart function and improve quality of life. Commonly used drugs include the following categories:

Endothelin receptor antagonists: such as bosentan, ambrisentan, etc. This type of drug can relieve the patient's symptoms by blocking the action of endothelin, dilating pulmonary artery blood vessels, and reducing pulmonary artery pressure. Endothelin is a powerful vasoconstrictor factor that plays an important role in the pathogenesis of pulmonary hypertension. Endothelin receptor antagonists can selectively bind to endothelin receptors, block the biological effects of endothelin, dilate blood vessels, and improve pulmonary circulation.

Bosentan: This is a dual endothelin receptor antagonist. The initial dose is generally 62.5 mg twice a day, taken orally. After 4 weeks, the dose can be increased to 125 mg twice a day. However, the specific dose adjustment needs to be made under the strict guidance of the doctor according to the patient's tolerance and treatment response. Pay attention to monitoring liver function during use, because it may cause liver damage. About 10%-15% of patients will experience elevated transaminases during medication, which is generally more common in the first 3-6 months after medication.

Ambrisentan: It is more selective and has a relatively small effect on liver function. The usual dose is 5 mg orally once a day. It can be taken on an empty stomach or after meals, and patients have good tolerance. Compared with bosentan, ambrisentan causes relatively fewer drug interactions and is more convenient to use.

Phosphodiesterase type 5 inhibitors: such as sildenafil, tadalafil, etc. This type of drug can increase the release of nitric oxide (NO) by inhibiting the activity of phosphodiesterase type 5, thereby dilating blood vessels and reducing pulmonary artery pressure. Nitric oxide is an important vasodilator factor that can relax vascular smooth muscle and dilate blood vessels. Phosphodiesterase type 5 inhibitors can inhibit the degradation of nitric oxide and increase its concentration in the body, thereby exerting a vasodilation effect.

Sildenafil: This drug is effective in improving exercise capacity and hemodynamic indicators in patients with pulmonary hypertension. The general dose is 20-60 mg three times a day, taken orally. It is best to use it 4-6 hours apart, and be aware that it may have side effects such as headache, flushing, and indigestion. A small number of patients may experience visual abnormalities, such as blurred vision and blue vision, but these side effects are usually short-lived and will gradually disappear after stopping the drug.

Tadalafil: The dosage is generally once a day, 40 mg each time, taken orally. The drug effect lasts relatively long, and some patients may have better compliance. Compared with sildenafil, the side effects of tadalafil are relatively mild and have less impact on daily life.

Prostacyclin drugs: such as epoprostenol, iloprost, etc. Prostacyclin is a substance with strong vasodilator and antiplatelet aggregation effects. Prostacyclin drugs can dilate pulmonary artery blood vessels, inhibit platelet aggregation, and improve patients' symptoms and prognosis through exogenous supplementation of prostacyclin. This type of drug can be administered by intravenous injection, inhalation, etc. Different administration methods are suitable for patients with different conditions.

Epoprostenol: It is a very strong vasodilator and platelet aggregation inhibitor. It is usually administered by continuous intravenous infusion, with the initial dose generally being 2-4 ng/kg per minute, and then the dose is gradually adjusted according to the patient's response. Due to its poor stability, it requires a special dosing device, such as a portable infusion pump, and has relatively more side effects, such as headache, diarrhea, toothache, etc. In addition, sudden discontinuation of epoprostenol may lead to worsening of the condition, so it is necessary to strictly follow the doctor's instructions during use to avoid self-discontinuation of the drug.

Iloprost: It can be administered by inhalation. The general inhalation dose is 2.5-5 μg per time, and it is inhaled 6-9 times a day. This administration method allows the drug to act directly on the pulmonary blood vessels, and the effect is rapid, but the duration of the drug effect is short. The side effects of inhaled iloprost are relatively mild, mainly including coughing, facial flushing, etc. Some patients may experience hypotension, so blood pressure needs to be closely monitored during medication.

Other drugs: In some cases, doctors may also use other drugs for auxiliary treatment according to the specific conditions of the patients. For example, for patients with right heart failure, diuretics (such as furosemide, spironolactone, etc.) may be used to reduce edema and reduce cardiac load; digoxin and other cardiotonic drugs may be used to enhance myocardial contractility and improve cardiac function. In addition, for some patients with other diseases, such as hypertension, diabetes, etc., corresponding drugs need to be used for treatment at the same time to control blood pressure, blood sugar and other indicators.

2. Oxygen therapy: Oxygen therapy is an important treatment measure for patients with pulmonary hypertension who have hypoxemia. By inhaling oxygen, the oxygen content in the blood can be increased, the hypoxic state of tissues and organs can be improved, and the burden on the heart and lungs can be reduced.

Oxygen therapy can be performed by nasal cannula or mask oxygen inhalation. The specific method and duration of oxygen inhalation need to be determined according to the patient's condition and blood oxygen saturation. Generally speaking, for patients with mild hypoxemia, nasal cannula oxygen inhalation can be used, and the oxygen flow rate is generally 1-3L/min; for patients with moderate to severe hypoxemia, mask oxygen inhalation may be required, and the oxygen flow rate can be adjusted to 4-6L/min or higher according to the condition.

The goal of oxygen therapy is to maintain the patient's blood oxygen saturation at a resting state above 90%. For some patients with more serious conditions, long-term or even lifelong oxygen inhalation may be required. During oxygen therapy, patients should pay attention to keeping the oxygen inhalation equipment clean and unobstructed, and avoid twisting and clogging of the oxygen inhalation tube. At the same time, blood gas analysis and other indicators should be reviewed regularly, and the oxygen inhalation plan should be adjusted according to the blood oxygen situation.

3. Lifestyle adjustments: Patients also need to make some adjustments in their daily lives to cooperate with treatment and improve their quality of life.

Pay attention to rest and avoid overwork and strenuous exercise. Overwork and strenuous exercise will increase the burden on the heart and lungs and aggravate the condition. Patients can choose some moderate exercise according to their physical condition, such as walking, Tai Chi, etc. The intensity of exercise should be such that they sweat slightly and feel slightly tired but can recover quickly after rest. At the same time, ensure adequate sleep, try to get 7 to 8 hours of sleep every night, good sleep helps the body recover and adjust.

Maintaining a healthy diet is also crucial. Reduce salt intake. Daily salt intake should be controlled below 5 grams. Too much salt will increase water and sodium retention and increase the burden on the heart. Avoid spicy, greasy and other irritating foods, such as peppers, fried foods, etc. These foods may irritate the gastrointestinal tract, affect digestion and absorption, and may also aggravate the body's inflammatory response. Eat more fresh vegetables and fruits. Vegetables are rich in vitamins, minerals and dietary fiber, which help maintain good health; fruits are rich in nutrients such as vitamin C and potassium, which are good for the heart and blood vessels. In addition, a moderate intake of high-quality protein, such as lean meat, fish, beans, eggs, etc., helps maintain the body's normal metabolism and immune function.

Patients also need to maintain a good attitude and face the disease positively. Pulmonary hypertension is a chronic disease. The treatment process may be long and complicated, and patients are prone to anxiety, depression and other negative emotions. These negative emotions will not only affect the patient's mental health, but may also have an adverse effect on physical recovery. Patients can share their feelings and gain emotional support by communicating with family and friends, participating in some patient mutual aid groups, etc. At the same time, you can also cultivate some hobbies, such as listening to music, reading, painting, etc., to divert attention, relieve psychological pressure, and maintain a positive and optimistic attitude.

4. Surgery: In some cases, surgery may be necessary.

For some pulmonary hypertension caused by congenital heart disease, surgery to repair the structural abnormalities of the heart may reduce pulmonary artery pressure and improve the patient's condition. For example, congenital heart diseases such as atrial septal defect and ventricular septal defect may significantly alleviate or even cure pulmonary hypertension after early surgical repair. However, if pulmonary hypertension has developed to a serious stage and irreversible pulmonary vascular lesions have occurred, the effect of surgical treatment may be affected.

For patients with chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy is an effective treatment. This surgery removes the thrombus and organized tissue in the pulmonary artery through thoracotomy or thoracoscopic surgery, restores the patency of the pulmonary artery, and reduces pulmonary artery pressure. For some patients who meet surgical indications, pulmonary endarterectomy can significantly improve symptoms, improve quality of life, and even prolong survival. However, this surgery is difficult and requires high technical skills from the surgical team. It is not suitable for all patients and requires strict evaluation and screening.

For patients with end-stage pulmonary hypertension, lung transplantation or combined heart-lung transplantation is an effective treatment, but the surgical risk is high and the surgical indications need to be strictly controlled. Lung transplantation is the transplantation of healthy donor lungs into the patient's body to replace diseased lung tissue and improve respiratory function and pulmonary hypertension. Combined heart-lung transplantation is suitable for patients with severe heart and lung diseases. Due to problems such as shortage of donor organs, surgical complications, and postoperative immune rejection, the application of lung transplantation and combined heart-lung transplantation is subject to certain restrictions. While waiting for donor organs, patients need to continue to receive medication and supportive treatment to maintain a stable condition.

4. Association of pulmonary hypertension with other symptoms

1. Pulmonary hypertension and pain between the left sternum and ribs

Pulmonary hypertension may cause pain between the left sternum and ribs. When pulmonary hypertension develops to a certain extent, it will cause overload on the right heart. When the right heart function is affected, it may cause myocardial ischemia and hypoxia, resulting in chest pain. This pain may radiate to the area between the left sternum and ribs.

At the same time, patients with pulmonary hypertension may experience right heart failure, leading to systemic congestion. This state of congestion may compress the organs and tissues in the chest or affect local blood circulation, indirectly causing discomfort between the left sternum and ribs. However, this symptom is not typical, and it is necessary to combine other symptoms of pulmonary hypertension such as dyspnea, fatigue, hemoptysis, and related examinations to comprehensively judge whether the pain is caused by pulmonary hypertension. For example, an electrocardiogram can rule out chest pain caused by heart diseases such as myocardial infarction; chest CT and other examinations can understand the structure of the lungs and chest, and determine whether there are other lesions causing pain.

2. Pulmonary hypertension and calf edema

Pulmonary hypertension can cause calf edema. Pulmonary hypertension can cause increased pressure in the right heart, and as the disease progresses, it can cause right heart failure. When the right heart fails, the heart cannot effectively pump blood into the pulmonary artery, which blocks venous blood return and causes blood to accumulate in the body's peripheral venous system.

This venous congestion will first appear in the low parts of the body, and the calf is one of the places where blood is more likely to accumulate. Increased venous pressure causes fluid to seep out of the blood vessels into the gaps between surrounding tissues, leading to edema. When you press the calf with your fingers, a depression may appear, and the recovery is slow. This is called pitting edema. As right heart failure worsens, edema may gradually spread upward to the thighs, buttocks and even the whole body. In addition to calf edema, patients may also experience edema in other parts of the body, such as ankle edema and scrotal edema. For patients with edema, doctors usually give diuretics and other medications according to the condition to relieve the symptoms of edema, while actively treating pulmonary hypertension and improving right heart function.