Pulmonary Hypertension

Definition and Classification of Pulmonary Hypertension:

· Pulm HTN is defined as a mean PAP >25mmHg at rest or >30 with exertion (measured by a RHC)

· echo estimates of RVSP are a close proximate for the PASP, with > 40mmHg indicating pulm HTN

· group 1 Pulm HTN is pulmonary arterial hypertension (previously known as primary pulmonary HTN) and is defined as above but with a PCWP <15 (which estimates the LA pressure)

· group 2 PH is due to L heart disease (either systolic, diastolic or valvular disease)

· group 3 PH is due to intrinsic lung disease (ILD, COPD, OSA etc.)

· group 4 PH is due to chronic thromboembolic disease

· group 5 PH is due to multifactorial disorders (basically, “other”)

Right heart catheterization and hemodynamics:

Normal pressures—

· RA: <5mmHg

· RV: 20/5mmHg

· PA: 20/10/25mmHg

· PCWP: 10mmHg

· Mean PA is calculated:  mPAP = [1/3] x sPAP + [2/3] x dPAP

· As noted above, PA systolic pressure >25mmHg at rest is indicative of Pulm HTN; if this is accompanied by a PCWP>15, it indicates elevated L sided pressure

(Victoria Kelly MD, 3/17/11)