Pulmonary Hypertension: The Daily PANCE Blueprint

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Pulmonary Hypertension: The Daily PANCE Blueprint

A 72-year-old male with a history of OSA, COPD, atrial fibrillation, and hypertension presents with external dyspnea and fatigue. On a physical exam you notice abdominal swelling, hepatomegaly, and lower extremity pitting edema. An echocardiogram is obtained showing a modearte decline in RV systolic function and an elevated RVSP of 62 mmHg. Which of the following groups of pulmonary hypertension does this patient most likely have?

A. WHO Group 1
B. WHO Group 2
C. WHO Group 3
D. WHO Group 4
E. WHO Group 5

Answer and topic summary

The answer is C. WHO Group 3

Pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure above 25 mmHg. The World Health Organization (WHO) lists 5 broad etiologies of PH: pulmonary arterial hypertension (Group 1), left heart disease (Group 2), lung disease (Group 3), chronic thromboembolism (Group 4), and unknown causes (Group 5).

Symptoms are usually related to right ventricle failure and include “body congestion” signs: ascites, abdominal swelling, pitting edema, hepatosplenomegaly, etc. A transthoracic echocardiogram should be used as an initial diagnostic test when PH is suspected. A right heart catheterization is the gold standard for diagnosing PH. Treatment depends on the etiology.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Pulmonary Circulation ⇒ Pulmonary hypertension

Also covered as part of the Internal Medicine PAEA EOR topic list

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