Contemporary Prospects for the Diagnostics and Treatment of the Chronic Pulmonary Hypertension

Overview

Pulmonary hypertension is defined as the rise of mean pressure in the pulmonary artery over 25 mmHg at rest or over 30 mmHg during activity with accompanying increase of pulmonary vascular resistance over 3 WU (Wood’s unit). According to the recent WHO classification from 2003 pulmonary hypertension can be categorized as pulmonary arterial hypertension, pulmonary venous hypertension, hypoxic pulmonary hypertension, chronic thromboembolic pulmonary hypertension and pulmonary hypertension from other causes. Because symptoms of the pulmonary hypertension are non-specific, the diagnosis is frequently late. Patients with higher risk of pulmonary hypertension require frequent echocardiographic examination. Treatment of the pulmonary hypertension is rather complex and economically demanding. It should be therefore centralized in specialized units. Decision on the pharmacotherapy is based on the acute pulmonary vasodilatation test. Only patients with the positive test (10% of patients) are indicated to the treatment with calcium channel blockers. In case of negative test, the treatment of choice in NYHA III stadium is bosentam per orally, in the NYHA IV stadium it is epoprostenol intravenously. In patients with chronic thromboembolic pulmonary hypertension, organized thrombotic material should be surgically removed together with the layer of the pulmonary artery (pulmonary endarterectomy) after preceding anticoagulation treatment lasting at least three months. Pulmonary hypertension center of the Cardiocenter of the General teaching hospital is the only unit in the Czech Republic which beside the complex therapy of the pulmonary arterial hypertension can employ also the surgical treatment of the chronic thromboembolic pulmonary hypertension. 

Key words:
pulmonary hypertension, pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, calcium channel blockers, bosentam, epoprostenol, anticoagulation treatment, pulmonary endarterectomy.