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The Cardiopulmonary Hemodynamic Evaluation of Pulmonary Hypertension

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Pulmonary Hypertension

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Abstract

Pulmonary hypertension, defined as mean pulmonary artery pressure ≥25 mmHg at rest as assessed by right heart catheterization, may be the end result of primary pathology of the pulmonary vasculature or of various other, systemic processes that affect the pulmonary vessels in either directly or indirectly. Pulmonary hypertension causes diverse effects on many other organs, the most important being the heart and specifically its right-sided chambers. Non-invasive and invasive methods to assess the severity of disease and the magnitude of cardiac effects have been extensively studied and many are now applied in clinical practice. This chapter will review in detail the evaluation of patients with pulmonary hypertension, including the methods used in the physical examination, echocardiogram and right heart catheterization, as well as guidance in interpretation of these results. Methods to evaluate the effects of the disease on the heart, to distinguish pulmonary hypertension caused by pulmonary vascular pathology from that caused by left heart disease, provocative maneuvers used to unveil pulmonary hypertension caused by left heart disease and pulmonary vasoreactivity testing are also discussed. Finally, we present the challenges of the diagnosis and treatment of special populations with pulmonary hypertension, such as adults with congenital heart disease.

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Authors and Affiliations

  1. Department of Cardiology, Boston Children’s Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Yonatan Buber MD

  2. Heart Institute, Sheba Medical Center, Tel Aviv University Faculty of Medicine, Ramat Gan, Israel

    Yonatan Buber MD

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yonatan Buber MD

  4. Department of Cardiology, Boston Children’s Hospital, Brigham and Women’s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Alexander R. Opotowsky MD, MPH, MMSc

Authors
  1. Yonatan Buber MD
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  2. Alexander R. Opotowsky MD, MPH, MMSc
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Correspondence to Alexander R. Opotowsky MD, MPH, MMSc .

Editor information

Editors and Affiliations

  1. Cardiovascular Medicine Dept, Harvard Medical School Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Bradley A. Maron

  2. Pulmonary & Critical Care Medicine, Stanford University Medical Center, Stanford, California, USA

    Roham T. Zamanian

  3. Pulmonary Critical Care Medicine Dept Cardiovascular Medicine Dept, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA

    Aaron B. Waxman

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Buber, Y., Opotowsky, A.R. (2016). The Cardiopulmonary Hemodynamic Evaluation of Pulmonary Hypertension. In: Maron, B., Zamanian, R., Waxman, A. (eds) Pulmonary Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-23594-3_11

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