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Pulmonary hypertension. New guidelines and diagnosis.
Professor Mark Humbert discusses the diagnosis of pulmonary hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) via Va/Q lung scans and the new possible treatment guidelines.
Pulmonary hypertension is a hot topic in respiratory medicine due to the publication of new guidelines that are shared between the European Society of Cardiology and the European Respiratory Society. Prof Humbert highlights one aspect from the guidelines, which is recognising chronic thromboembolic pulmonary hypertension. It should never be missed, as it is a curable subset of pulmonary hypertension defined by an increased mean pulmonary artery pressure of >25 mmHG and are the result of clots that have blocked the small or large pulmonary arteries. These clots can be removed by a surgeon. The diagnosis is straightforward; when pulmonary hypertension is present, start with a VAQ (ventilation-perfusion) lung scan that may show perfusion defects in the lung, indicating scars from previous clots.
Chronic thromboembolic pulmonary hypertension may appear with no previous history of acute thromboembolic pulmonary hypertension. If screening reveals chronic thromboembolic pulmonary hypertension, then further investigations should be undertaken in expert centers with multi-disciplinary teams. Prof Humbert reviews the treatment options that these teams may adopt in order to provide the best care possible.