Pulmonary hypertension due to left heart disease

Pulmonary hypertension due to left heart disease

Updated: 09/14/2022

© Jun Wang, MD, PhD

 

General features
  • Post-capillary pulmonary hypertension
  • Commonly seen in pts with heart failure
  • Usually poor prognosis

Subclassification

  • Isolated post-capillary PH (Ipc-PH): Elevated mPAP solely due to passive transmission of increased left-sided filling pressure to the pulmonary circulation
  • Combined post- and precapillary PH (Cpc-PH): Elevated mPAP due to passive transmission of increased left-sided filling pressures with superimposed pulmonary vascular disease

Pathogenesis

  • Response to increase in left-side filling pressure

 


Clinical features

  • Presentation of left heart diseases
    • History of left heart diseases: infarct, etc
    • Left ventricular dysfunction
    • Pulmonary crackles
    • S3 or S4 heart sound
  • Presentation of right heart failure
    • Loud P2
    • Right ventricular heave
    • Elevated jugular vein
    • Hepatomegaly
  • Presentation of pulmonary hypertension

Key morphological features

  • Proliferative vasculopathy

Diagnosis

  • Confirmation of pulmonary hypertension
  • Right heart catheterization
    • PAPm ≥ 25 mm Hg
    • PAWP > 15 mm Hg
    • Pulmonary vascular resistance (PVR) ≥ 3 mm Hg if Cpc-PH
    • PVR < 3 mm Hg if Ipc-PH

Treatment

  • Management of underlying left heart diseases
  • Systemic vasodilator

 

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