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“Yesterday is history, tomorrow is a mystery, but today is a gift. That is why it is called the present.”

Kung Fu Panda (DreamWorks Animation).

Pulmonary Arterial Hypertension (PAH)

This is a feared complication in several situations.

Thromboembolism (TE):

Originates usually in lower legs and is most frequent in elderly women.

A deficit in Vitamin B12 is common in third age.

This vitamin abundant in our nutrition needs the so-called Intrinsic Factor, secreted by parietal stomach cells (PSC) to be absorbed by the small intestine.

PSC degenerate owing to most frequent autoimmune disorder.

A hypercoagulability state installs little by little and patients are not immediately aware of this.

Hence, if the TE event does not kill immediately, PAH is often at hand.

Here the heart starts struggling more and more and several symptoms and signs can be observed.

Peripheral Arterial Hypertension (PeAH) is the most common constatation.

Here professionals prescribe typically inadequate medicine, but this is the occasion for nearer examination and surveillance.

A slight heart rate acceleration can be thus observed.

If the patient is out of breath, an effort test can disclose bradycardia instead of tachycardia.

This is probably the neuro-vegetative system is overwhelmed, especially for its sympathetic component.

Hence, its para-sympathetic counterpart is trying to dilate the pulmonary vascular bed.

Bradycardia can be observed in top athletes, especially cyclists.

PDE5-Inhibitors, like Viagra and Cialis can be used in PAH.

Most important in TE are anticoagulants.

Other etiologies of PAH:

Vertebroplasties have been used for decades in Europe.

Here, a huge quantity of acrylic glue embolizes to the lungs.

Many times, it goes unnoticed but restrains the vascular bed.

It is important to explain here the procedure.

Acrylic glues were first used by orthopedic surgeons for articular prostheses.

Quickly it became obvious, especially in the hip, that the glue was inoperant, and thus appeared so-called auto-blocking devices, that is without glue.

Well trained surgeons know that all prostheses are in fact “auto-blocking”.

It never holds the bone together, if the edges are not precisely adapted to each other.

Hence, from this point of view vertebroplasties have no sense!

Bone callus forms little by little and the fracture heals.

Osteoporosis ends in spinal deformities and shorter stature.

On the other hand, patients were extremely satisfied with the procedure, because it relieved pain on the spot.

Hot acrylic glue burns extremely efficiently the tiny nerve endings in the fracture.

On rare occasions big quantities of glue end in the lungs with interventions on arterio-venous malformations and fistulas.  

The lungs are the organ in the body with the most efficient system of proteinases, but against glue of this sort it has no weapon.

Future:

Personally, I hope near future will provide professionals with more adapted glues of organic material.

Collagen ones have been used for a long time in the past, for gluing leather, in bags for instance.

Modern science should be able to produce a collagen glue for our needs (Orthopedics, Dentistry…).

Such a material can be incorporated progressively in bone, tooth enamel and dentine, and can be destroyed by lung proteinases.

Vessel wall renewal takes at least 3 years in young age, and probably much longer in elders.

Thus, waiting time is at least for 3 years, until you are sure having survived a procedure embolizing acrylic glue.

But, as my previous chief and friend Jürg would put it:

“Interventions are the best means of separating the two big groups, survivors and non-survivors!”