Diagnosis and treatment of pulmonary hypertension: a literature review

Abstract

The finding of pulmonary hypertension (PH) on echocardiographic evaluation is frequent and worrying. However, the echocardiogram is only a suggestive and not a diagnostic test for PH. When direct involvement of the pulmonary circulation is suspected, invasive hemodynamic measurement is indicated to establish the diagnosis. This assessment allows, in addition to diagnostic confirmation, the correct identification of the predominantly affected vascular territory (pulmonary arterial or post-capillary). Treatment with specific PH medications (phosphodiesterase 5 inhibitors, endothelin receptor antagonists, prostacyclin analogues and soluble guanylyl cyclase stimulator) is proven effective for patients with pulmonary arterial hypertension, but their use in patients with PH resulting from disease left chamber heart disease can even be harmful. In this review, we will discuss the diagnostic criteria, the way to carry out the etiological investigation, the clinical classification and, finally, the therapeutic recommendations in PH.