Pulmonary hypertension and right heart failure are common enough in the ICU, and it makes sense for them to appear repeatedly in the CICM exams. In the past papers, pulmonary hypertension crops up now and then as a sideshow to some other major problems, or as a comorbidity to discuss. For instance:
The update article by Siomonneau (2013) is an excellent resource for this answer, and is used to generate the table offered below. For a more thorough review of this disease process, one may look at the massive 2022 ESC/ERS guidelines, or the defunct 2015 Guidelines.
The list used by the college answer is the updated 2013 Dana Point classification, which can be found in the Siomonneau article in Table 1. The objective of such a clasification was to join into groups pulmonary hypertensive diseases which share "similar pathological findings, similar hemodynamic characteristics and, similar management".
In brief, the WHO recognises 5 major groups of disease which fall under the pulmonary hypertension heading:
In detail:
Group 1: Pulmonary Arterial Hypertension |
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Group 2: Left heart disease |
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Group 3: Lung disease or hypoxia |
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Group 4: Thromboembolism |
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Group 5: Pulmonary hypertension due to unclear or multifactorial aetiologies |
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These "PH WHO" groups are also known as the Dana Point classification system, so named because the original 2008 symposium on pulmonary hypertension was held in Dana Point, Ca. The system it superceded was the Evian-Venice classification, which was not hugely different, and which interested students of history can review in Simonneau et al (2004).
Humbert, Marc, et al. "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension." European Respiratory Journal (2022).
Simonneau, Gérald, et al. "Updated clinical classification of pulmonary hypertension." Journal of the American College of Cardiology 54.1s1 (2009): S43-S54.
Simonneau, Gerald, et al. "Updated clinical classification of pulmonary hypertension." Journal of the American College of Cardiology 62.25 (2013): D34-D41.
Galiè, Nazzareno, et al. "2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension." European heart journal (2015): ehv317.
van Albada, Mirjam E., and Rolf MF Berger. "Pulmonary arterial hypertension in congenital heart disease: the need for refinement of the Evian-Venice classification." Pulmonary arterial hypertension (2007): 27.
Simonneau, Gerald, et al. "Clinical classification of pulmonary hypertension." Journal of the American College of Cardiology 43.12S (2004): S5-S12.