Pulmonary Hypertension in Chronic Heart and Lung Disease

Abstract

Pulmonary hypertension commonly accompanies left heart disease (Group 2 Pulmonary Hypertension in the Dana Point classification scheme), and often accompanies hypoxic/parenchymal lung disease (Group 3). The phenotypic and hemodynamic spectrum of pulmonary hypertension in these settings is enormous, and the clinician is often left with uncertainty regarding the appropriate evaluation and management of these patients. A comprehensive understanding of the prognostic significance of pulmonary hypertension, and appropriate strategies for its evaluation and management, is critical for practitioners caring for these challenging patients. Management of pulmonary hypertension in the setting of left heart disease focuses primarily on identification and management of factors such as hypoxemia or pulmonary emboli that may be superimposed on left heart disease, and on optimization of conventional heart failure therapy. An evolving role for pulmonary vasoactive therapy is foreseen. In parenchymal lung disease, pulmonary hypertension often portends a poor prognosis, but whether there is a role for pulmonary vasoactive therapy beyond correction of hypoxemia is a matter of much debate. This chapter provides a comprehensive review of the current understanding of these important issues.