Pulmonary Hypertension: Definition and Diagnosis

Pulmonary Hypertension Definition, Classification, and Diagnosis

• Pulmonary Hypertension (PH): A haemodynamic condition characterized by elevated mean pulmonary arterial pressure (mPAP) >20 mmHg, measured by right heart catheterization.

• Pre-capillary PH: mPAP >20 mmHg, elevated pulmonary vascular resistance (PVR) >2 Wood Units (WU), and pulmonary arterial wedge pressure (PAWP) ≤15 mmHg. Characterizes conditions where the problem is before the capillaries.

• Isolated post-capillary PH (ipcPH): mPAP >20 mmHg, PAWP >15 mmHg, and PVR ≤2 WU. Suggests left heart disease.

• Combined post- and pre-capillary PH (cpcPH): mPAP >20 mmHg, PAWP >15 mmHg, and PVR >2 WU. Indicates problems in both the capillaries and the area before it.

• Exercise PH: mPAP at rest is normal, but increases abnormally during exercise (mPAP/cardiac output slope >3 mmHg/L/min). Demonstrates a response to exertion.

Clinical Classification of PH

• The core structure of the clinical classification of PH, including five major groups, is retained.

• Key changes include: the re-introduction of "long-term responders to calcium channel blockers" in idiopathic pulmonary arterial hypertension, subgroups within group 2 PH, and a shift to classifying group 3 PH subgroups based on pulmonary diseases instead of functional abnormalities.

• The diagnostic approach focuses on identifying patients requiring referral to a PH center for invasive evaluation, with priority given to patients with potential severe pulmonary vascular disease or right-heart failure signs.

This quiz covers the definitions, classifications, and diagnostic criteria for pulmonary hypertension (PH). Learn about pre-capillary, post-capillary, and exercise PH, as well as the hemodynamic parameters involved. Test your understanding of this important cardiovascular condition.