Coughing up of blood may occur in some patients, particularly those with specific subtypes of pulmonary hypertension such as heritable pulmonary arterial hypertension, Eisenmenger syndrome and chronic thromboembolic pulmonary hypertension. Pulmonary venous hypertension typically presents with shortness of breath while lying flat or sleeping (orthopnea or paroxysmal nocturnal dyspnea), while pulmonary arterial hypertension (PAH) typically does not.Other typical signs of pulmonary hypertension include an accentuated pulmonary component of the second heart sound, a right ventricular third heart sound, and parasternal heave indicating a hypertrophied right ventricle. Signs of systemic congestion resulting from right-sided heart failure include jugular venous distension, ascites, and hepatojugular reflux. Evidence of tricuspid insufficiency and pulmonic regurgitation is also sought and, if present, is consistent with the presence of pulmonary hypertension. Causes
Pulmonary hypertension is a pathophysiologic condition with many possible causes. Indeed, this condition frequently accompanies severe heart or lung conditions. A 1973 World Health Organization meeting was the first attempt to classify pulmonary hypertension by its cause, and a distinction was made between primary PH (resulting from a disease of the pulmonary arteries) and secondary PH (resulting secondary to other, non-vascular causes). Further, primary PH was divided into the "arterial plexiform", "veno-occlusive" and "thromboembolic" forms. In 1998, a second conference at Évian-les-Bains addressed the causes of secondary PH. Subsequent third, fourth, and fifth (2013) World Symposia on PAH have further defined the classification of PH.
After a devastating battle of 9 September 1730, in Illinois, in which hundreds of warriors were killed and many women and children taken captive by French allies, Fox refugees took shelter with the Sac. This made them subject to French attack in turn. The Sac continued moving west to Iowa and Kansas. Keokuk and Black Hawk were two important leaders who arose among the Sauk. At first Keokuk accepted the loss of land as inevitable in the face of the vast numbers of white soldiers and settlers coming west. He tried to preserve tribal land and his people, and to keep the peace. Having failed to receive expected supplies from the Americans on credit, Black Hawk wanted to fight, saying his people were "forced into war by being deceived". Led by Black Hawk in 1832, the mainly Sac band resisted the continued loss of lands (in western Illinois, this time.) Their warfare with United States forces resulted in defeat at the hands of General Edmund P. Gaines in the Black Hawk War. Oklahoma history
About this time, one group of Sac moved into Missouri, and later to Kansas and Nebraska. In 1869, after the Civil War, the United States forced the larger group of Sac to move into a reservation in Indian Territory (now the state of Oklahoma). They merged with the Meskwaki as the federally recognized Sac and Fox Nation. (The United States had been making treaties with the two tribes together since their residency in the Midwest.)