open access

Vol 89, No 4 (2021)
Case report
Published online: 2021-07-16
Submitted: 2020-06-09
Accepted: 2020-09-16
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Diagnosis and management of combined post- and precapillary pulmonary hypertension in a patient with multiple comorbidities

Evangelia Panagiotidou1, Afroditi Boutou2, Evgenia Kalamara1, Evdokia Sourla1, Evangelos Chatzopoulos1, Ioannis Stanopoulos1, Georgia Pitsiou1
DOI: 10.5603/ARM.a2021.0047
·
Pubmed: 34269398
·
Adv Respir Med 2021;89(4):444-447.
Affiliations
  1. Respiratory Failure Clinic, General Hospital of Thessaloniki „G. Papanikolaou”, Aristotle University of Thessaloniki, Thessaloniki, Greece
  2. Department of Respiratory Medicine, General Hospital „G. Papanikolaou”, Thessaloniki, Greece

open access

Vol 89, No 4 (2021)
CASE REPORTS
Published online: 2021-07-16
Submitted: 2020-06-09
Accepted: 2020-09-16

Abstract

Diagnosis of pulmonary hypertension requires a laborious investigation that must be performed in accordance with international guidelines. Right-heart catheterization is the gold standard examination to assess the degree of hemodynamic impairment of  post- or precapillary origin, guiding management. The presence of comorbidities is becoming rather frequent in real-life pulmonary hypertension cases, thus creating diagnostic and therapeutic complexity. We present a case of combined post- and precapillary pulmonary hypertension in a patient with ischemic heart disease and combined pulmonary fibrosis and emphysema, in order to describe the diagnostic algorithm for pulmonary hypertension and elucidate the problematic aspects of managing this debilitating disease in a patient with several comorbidities. Current guidelines do not support the use of specific vasodilator treatment in group II — due to heart disease and group III-due to lung disease pulmonary hypertension, unless the patient presents with severe pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg or cardiac index < 2.0 L/min) with right ventricular dysfunction and is treated in an expert center and preferably in the context of a randomized control trial. In the case presented, therapeutic management focused, firstly, on treatment of the underlying heart and lung disease and, subsequently, on specific vasoactive therapy, due to severe hemodynamic deterioration.

Abstract

Diagnosis of pulmonary hypertension requires a laborious investigation that must be performed in accordance with international guidelines. Right-heart catheterization is the gold standard examination to assess the degree of hemodynamic impairment of  post- or precapillary origin, guiding management. The presence of comorbidities is becoming rather frequent in real-life pulmonary hypertension cases, thus creating diagnostic and therapeutic complexity. We present a case of combined post- and precapillary pulmonary hypertension in a patient with ischemic heart disease and combined pulmonary fibrosis and emphysema, in order to describe the diagnostic algorithm for pulmonary hypertension and elucidate the problematic aspects of managing this debilitating disease in a patient with several comorbidities. Current guidelines do not support the use of specific vasodilator treatment in group II — due to heart disease and group III-due to lung disease pulmonary hypertension, unless the patient presents with severe pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg or cardiac index < 2.0 L/min) with right ventricular dysfunction and is treated in an expert center and preferably in the context of a randomized control trial. In the case presented, therapeutic management focused, firstly, on treatment of the underlying heart and lung disease and, subsequently, on specific vasoactive therapy, due to severe hemodynamic deterioration.

Get Citation

Keywords

diagnostic algorithm; combined post- and pre-capillary pulmonary hypertension; combined pulmonary fibrosis and emphysema

About this article
Title

Diagnosis and management of combined post- and precapillary pulmonary hypertension in a patient with multiple comorbidities

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 4 (2021)

Article type

Case report

Pages

444-447

Published online

2021-07-16

DOI

10.5603/ARM.a2021.0047

Pubmed

34269398

Bibliographic record

Adv Respir Med 2021;89(4):444-447.

Keywords

diagnostic algorithm
combined post- and pre-capillary pulmonary hypertension
combined pulmonary fibrosis and emphysema

Authors

Evangelia Panagiotidou
Afroditi Boutou
Evgenia Kalamara
Evdokia Sourla
Evangelos Chatzopoulos
Ioannis Stanopoulos
Georgia Pitsiou

References (15)
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