Diagnostics (scientific)

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PH Diagnostics (scientific)

Maria Klara Frey, Irene Lang
Clinical Cardiology Department, University Internal Medicine Clinic II,
Vienna Medical University, Austria

Indtroduction

Although the disease “pulmonary hypertension” (PH) was described as long as 100 years ago, even today there is no comprehensive explanation of its pathogenesis, and nor are there currently any prospects of a cure for this disease.

Definition

The term PH is used if the average pressure in the pulmonary arterial system is ≥ 25 mmHg. Values below 20 mmHg are regarded as normal, values of between 21 and 24 mmHg are described as borderline (“borderline PH”).

Pathogenesis

PH is characterised by an increase in pulmonary arterial pressure and progressive obliteration of the vasculature. This results in right ventricular hypertrophy and/or dilatation, subsequently to right heart insufficiency and death from right heart failure.

Classification

In the past, a distinction was made between primary (idiopathic) pulmonary hypertension of unknown cause and a secondary form resulting from underlying diseases. However, this concept was dropped at the WHO 3rd Symposium on Pulmonary Hypertension in 2003 in Venice as a result of new scientific findings about the pathophysiology, molecular biology and clinical symptoms.

Diagnostics

The keys to diagnosis are a detailed history and thorough clinical examination of the patient. The affected person should be transferred to a specialist centre for clarification. Only those patients in whom the risk of developing PH is substantially raised should undergo screening.

Treatment

Therapy goals are an improvement in symptoms, quality of life and survival. Changes in functional capacity (6-minute walk test, ergometry, etc.) and haemodynamics are used to assess therapeutic success. In principle, PH patients should always be managed by specialist centres.

Surgical Therapies

1. Atrial septostomy The creation of this right-left shunt is indicated in cases of right heart failure and syncope despite maximum conservative therapy. The aim is to reduce the right ventricular end-diastolic pressure. This procedure may also be used as a bridging measure before other forms of treatment.

References

1. Atrial septostomy The creation of this right-left shunt is indicated in cases of right heart failure and syncope despite maximum conservative therapy. The aim is to reduce the right ventricular end-diastolic pressure. This procedure may also be used as a bridging measure before other forms of treatment.