Cardiovascular

Pulmonary hypertension

Pulmonary hypertension is a haemodynamic disorder in which the pulmonary circulation places an abnormal load on the right ventricle; diagnosis requires specialist classification because treatment differs between pulmonary arterial, left-heart, lung-disease, chronic-thromboembolic and multifactorial disease.

Definition

Pulmonary hypertension is a haemodynamic disorder defined by a mean pulmonary arterial pressure above 20 mmHg at rest on right-heart catheterisation. Pre-capillary and post-capillary patterns are separated using pulmonary arterial wedge pressure and pulmonary vascular resistance, then classified clinically into five groups by mechanism.

First principles

Pulmonary hypertension is a haemodynamic diagnosis, not an echocardiographic label

The current ESC/ERS definition is a mean pulmonary arterial pressure above 20 mmHg at rest, confirmed by right-heart catheterisation. Pre-capillary disease additionally requires a pulmonary arterial wedge pressure of 15 mmHg or less and pulmonary vascular resistance above 2 Wood units; post-capillary disease is defined by the wedge-pressure relationship. An echocardiogram estimates probability and mechanism but does not confirm the diagnosis.

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