[Vaskuläre Dyspnoe: Pulmonale Hypertonie].

Abstract

Introduction: Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure > 20 mmHg [1] [2]. Echocardiography is used to screen for pulmonary hypertension, but right heart catheterization is required to confirm the diagnosis. Right heart catheterization is used to measure hemodynamic parameters such as pulmonary arterial pressures and pulmonary artery wedge pressure (PAWP), which normally corresponds to the left ventricular end-diastolic pressure. In addition, cardiac output (CO) is measured using the direct Fick method or thermodilution. The pulmonary vascular resistance (PVR) can be derived from these values. Precapillary PH is defined by PAWP ≤15 mmHg and PVR >2 WU (wood units), postcapillary PH is defined by increased PAWP > 15 mmHg with PVR 2 WU due to passive backflow [3]. However, there are also combined pre- and post-capillary PH with a PAWP > 15 mmHg and elevated PVR > 2 WU. Supportive therapies for all forms of PH include diuretics, supplemental oxygen in case of hypoxemia, gentle exercise under specialized supervision, and anticoagulants for some forms. Specific drug or interventional therapies are available only for pulmonary vascular disease subgroups pulmonary arterial hypertension (group 1) and chronic thromboembolic PH (CTEPH, group 4), while for PH due to heart and lung diseases (groups 2 and 3) as well as mixed forms the therapy of the underlying disease is of major importance. Drug therapy for pulmonary vascular diseases includes endothelin receptor antagonists, phosphodiesterase-5 inhibitors and prostanoids. CTEPH requires clarification regarding surgical pulmonary endarterectomy or interventional balloon angioplasty [4]. Since the diagnosis and therapy of PH is very complex, it must be carried out in an experienced center.