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INTRODUCTION

Key Clinical Questions

  • image How does the classification system for pulmonary hypertension (PH) aid in understanding the pathophysiology, diagnostic evaluation, and treatments for this condition?

  • image What signs and symptoms might increase the suspicion for elevated pulmonary arterial pressures?

  • image What is a rational diagnostic approach to suspected PH?

  • image What is the meaning of an elevated pulmonary pressure determined by echocardiography?

  • image When should right heart catheterization be considered in the evaluation of suspected PH?

  • image What are the key steps in the evaluation and management of acute right heart failure secondary to elevated pulmonary arterial pressure?

  • image What are the common side effects of the medications used to treat PH?

Pulmonary hypertension (PH) is simply defined as a mean pulmonary arterial pressure > 25 mm Hg at rest. However, this deceptively simple definition encompasses a broad spectrum of clinical entities. In this chapter, we will present an evidence-based approach to the care of the patient with elevated pulmonary arterial pressures. Table 237-1 lists landmark studies supporting the approach presented in this chapter.

TABLE 237-1Evidence-based Key References: Pulmonary Hypertension

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