36. The Little Ventricle That Could- Pulmonary Hypertension

Pulmonary hypertension, its classification, diagnosis, and management are discussed. The condition is divided into five groups based on the WHO classification, each related to different parts of the heart-lung circuit. Initial diagnostic steps include ECG and echocardiogram to assess right ventricular strain and potential left heart involvement, followed by serologic tests to rule out underlying causes like liver dysfunction or rheumatologic conditions. Pulmonary function tests and non-contrast CT scans help evaluate lung disease contributions, while VQ scans detect chronic thromboembolic pulmonary hypertension (CTEF). Right heart catheterization remains the gold standard for confirming pulmonary hypertension, using specific pressure and resistance criteria. Management strategies vary based on the underlying cause, ranging from diuretics and oxygen supplementation to targeted vasodilators and, in severe cases, lung transplantation. The diagnostic threshold for mean pulmonary arterial pressure has been updated from 25 mmHg to 20 mmHg.