Pulmonary Hypertension

Elevated pressure in the pulmonary arteries > 25 mmHg, resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles

Aetiology

Pulmonary venous hypertension

• Left ventricular systolic dysfunction

• Mitral regurgitation/stenosis

• Cardiomyopathy e.g. alcohol, viral

Pulmonary arterial hypertension

• Primary arterial hypertension: primary disease of the pulmonary arteries/arterioles

• Secondary arterial hypertension: occurs due to underlying disease or known risk factors, most commonly heart disease (e.g. congenital shunts) and lung fibrosis (e.g. COPD, OSA, pulmonary fibrosis)

Clinical presentation

Symptoms

• Fatigue

• Dyspnoea

• Chest pain

• Central cyanosis if hypoxic

Signs

• Dependent oedema

• Elevated JVP

• Right ventricular heave at left parasternal edge

• Murmur of tricuspid regurgitation

• Loud P2

• Enlarged liver (pulsatile)

Investigations

• ECHO doppler - estimates systolic pulmonary arterial pressure

• Right heart catheterization to confirm

• Others: ECG (right axis deviation, RBBB), CXR (cardiomegaly)

Management

• Depends on cause

Complications

Cor pulmonale

• Pulmonary hypertension will increase right ventricular afterload → right ventricular hypertrophy/dilation → right sided heart failure