Fundamentals of diagnosis and treatment of pulmonary hypertension associated with left heart disease: a clinical case

Authors

  • G.D. Radchenko State Institution “National Scientific Center “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
  • S.M. Kushnir State Institution “National Scientific Center “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
  • Yu.M. Sirenko State Institution “National Scientific Center “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-1485.13.4.2020.211958

Keywords:

pulmonary hypertension, diagnosis, treatment, left heart diseases, clinical case, guidelines

Abstract

This paper presents a clinical case of pulmonary hypertension associated with left heart disease (PH-LHD) in a 63-year-old woman with heart failure and preserved ejection fraction (HFpEF). The history of disease (arterial hypertension, atrial fibrillation, diabetes mellitus, acute pulmonary embolism, obesity, chronic obstructive pulmonary disease) and results of standard instrumental (no signs of thrombi in pulmonary arteries, significant enlargement of right heart and normal size of left heart, high level of calculated systolic blood pressure in pulmonary artery) and laboratory investigations (high level of B-type natriuretic peptide) did not help to classify the type of pulmonary hypertension. Only after right heart catheterization it was possible to establish the correct diagnosis — post capillary combined PH-LHD. The article also discussed the latest guidelines on the diagnosis and treatment of HFpEF and PH-LHD. Some considerations in favor of new step algorithm for diagnosis of HFpEF that was proposed by European Society of Cardiology Congress in Paris (2019) were done and there was demonstrated its possible use in Ukraine. Some questions of morphological and pathogenic differences between precapillary pulmonary arterial hypertension and post-capillary PH-LHD were discussed. Conclusion about the impossibility of using specific pulmonary arterial hypertension therapy in patients with post-capillary PH was based on some arguments. There are elucidated some drug interventions in patients with HFpEF. Particular emphasis is placed on the correction of risk factors and comorbidities, in particular through lifestyle modifications and non-drug treatment.

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Published

2020-08-01

Issue

Section

To help clinicians