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, in Question 12 from the second paper of 2017 the patient has among other things pulmonary hypertension, and the candisates were asked to discuss their periop Question 2 from the second paper of 2015 asks the candidates to identify the causes of pulmonary hypetension. 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 2015 ESC/ERS Guidelines.
Classification of pulmonary hypertension
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, there are 5 major groups of disease which fall under the pulmonary hypertension heading:
- Pulmonary arterial hypertension
- associated with connective tissue disease
- Congential or heriable
- Due to portal hypertension
- Pulmonary hypertension due to left heart disease
- LV systolic or diastolic dysfunction
- Valve disease
- Congential cardiomyopathies
- Pulmonary hypertension due to lung disease or hypoxia
- Idiopathic pulmonary fibrosis
- OSA/obesity hypoventilation syndrome
- Chronic exposure to high altitude
- Pulmonary hypertension due to chronic PE
- Pulmonary hypertension due to "unclear multifactorial mechanisms"
- Myeloproliferative diseases
- Haemolytic anaemias and MAHA
- Sarcoidosis, pulmonary histiocytosis
- Tumour obstruction
- Fibrosing mediastinitis
Classification of pulmonary arterial hypertension (PAH)'
Pulmonary Arterial Hypertension
|Left heart disease||
|Lung disease or hypoxia||
|Pulmonary hypertension due to unclear or multifactorial aetiologies||