MEM Cast Episode 151: Pulmonary hypertension- treatment and outcome
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Feb 25, 2023 
Dr Patrick Davey, consultant cardiologist and pulmonary hypertension expert, joins to discuss measurement and management. He covers right heart catheterisation and when to use it. Treatment is tailored to cause with diuretics, oxygen, anticoagulation, targeted endothelial drugs, and surgical options like thromboendarterectomy. Referral to specialist centres and transplantation limits are also explored.
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Treat Reversible Causes Before Specialist Therapies
- Do investigate reversible causes of pulmonary hypertension and treat them first, such as COPD, left heart disease, valve disease, or coronary disease.
- Use targeted treatments (oxygen, diuretics, heart failure meds) and consider surgery cautiously because pulmonary hypertension increases operative risk.
Anticoagulate And Reassess After Pulmonary Embolism
- Anticoagulate patients with pulmonary emboli lifelong once pulmonary hypertension is present or suspected.
- Reassess right heart pressures and perform V/Q at 3–6 months to detect persistent perfusion defects that might need intervention.
Consider Pulmonary Endarterectomy In Selected Patients
- Refer fit patients with persistent high mean pulmonary artery pressure (eg >50 mmHg) and residual perfusion defects for consideration of pulmonary endarterectomy.
- Only centres with quaternary expertise (eg Papworth) should perform this complex, bloody surgery.