[Diagnosis and treatment of pulmonary hypertension: current concepts]

Abstract

Pulmonary hypertension is diagnosed when pulmonary artery pressure is above 25 mm Hg at rest and 30 mm Hg during exercise; it can be primary or secondary if complicates some basic disease. Untreated pulmonary hypertension leads to progressive right ventricular failure and is associated with high risk of sudden death. Necessary components of management of any variant of pulmonary hypertension are limitation or avoidance of isometric exercise, yearly influenza and pneumococcal vaccination, and active treatment of pulmonary infections. Drug therapy is aimed at three main pathophysiological mechanisms: thrombosis, vasoconstriction and proliferation. Anticoagulants and vasodilators (calcium antagonists, nitric oxide, and prostacyclin or its derivatives) constitute basis of treatment of pulmonary hypertension. However principally novel drugs such as endothelin receptor antagonists has been also suggested. Diuretics, digitalis and oxygen are added when necessary. Gene therapy has been considered as potential future intervention. Surgical approaches comprise mitral valvuloplasty or mitral valve replacement and embolectomy in case of major pulmonary artery branch thromboembolism. In cases of other treatment failure lung or heart-lung transplantation is appropriate but can not widely used.