Pulmonary hypertension

Pulmonary hypertension

Updated: 10/07/2022

© Jun Wang, MD, PhD

 

Definition

  • Elevated pulmonary arterial pressure
    • ≥ 25 mm Hg (or 20 mm Hg + Pulmonary vascular resistance ≥ 3 Woods units, debating), or 
    • > 30 mm Hg during exercise
  • Severe pulmonary hypertension
    • mPAP is ≥ 35 mm Hg, or
    • mPAP is > 20 mm Hg with an elevated right atrial pressure (>14 mm Hg) and/or the cardiac index is <2 L/min/m2
  • Post-capillary pulmonary hypertension

WHO classification

Clinical presentations

  • Non-specific
  • Commonly with exertional dyspnea and progressive fatigue
  • Symptoms and signs of right ventricular dysfunction
    • Exertional chest pain or syncope
    • Weight gain
    • Anorexia, abdominal pain and swelling
    • Elevated jugular vein pressure
    • Right-sided 3rd or 4th heart sound,
    • Splitting of 2nd sound, or loud S2, due to increased P2 intensity 
    • Hepatomegaly, etc

Diagnostic approaches

Laboratory tests

  • Results consistent with underlying disorders
  • Brain natriuretic peptide might be elevated, but not specific

Treatments

  • Depending on classification

Practice questions

 

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