Medscape InDiscussion: Heart Failure S2 Episode 5: Pulmonary Hypertension: Essential Insights for Cardiologists
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Apr 18, 2024 
Ronald Oudiz, cardiologist and pulmonary hypertension specialist who directs a PH center, shares practical clinical guidance. He explains when to investigate raised RVSP, why right heart catheterization is essential, and how to distinguish PH types using wedge and LVEDP. He stresses optimizing heart failure therapy for group 2 PH and advises partnering with PH centers for complex cases.
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Use Demographics And Echo Phenotype To Triage Pulmonary Hypertension
- Echo findings must be interpreted with patient age, sex, symptoms, and cardiac morphology to estimate PH cause.
- Ronald Oudiz contrasts an elderly male with AF and RVSP 40–50 versus a young scleroderma woman with RVSP ~80 and dilated RV as triggers to act.
Confirm Pulmonary Hypertension With Right Heart Catheterization
- Confirm suspected pulmonary hypertension with right heart catheterization rather than relying solely on echo estimates.
- Ronald Oudiz emphasizes the day you document PH in the cath lab as the official start of diagnosis and workup.
Verify Wedge Pressures And Use LVEDP When In Doubt
- Use pulmonary capillary wedge pressure and, when uncertain, directly measure LVEDP to differentiate group 2 versus precapillary PH.
- Oudiz recounts a case where wedge was reported 28 but LVEDP was 12, so confirm measurements when they don't fit the clinical picture.