MEM Cast Episode 149: Pulmonary hypertension diagnosis
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Feb 11, 2023 
Dr Patrick Davy, consultant cardiologist specializing in pulmonary hypertension, joins to unpack diagnosis. He defines pressure thresholds and practical classification. He covers left-heart and lung causes, thromboembolism and congenital contributors. He highlights symptoms, bedside clues, ECG/CXR, echo limitations and why right heart catheterization and imaging are essential.
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Pulmonary Hypertension Defined But Numbers Are Limited
- Pulmonary hypertension (PH) is a pathological rise in pulmonary artery pressure, defined >25 mmHg at rest or >30 mmHg on exercise.
- Patrick Davy notes symptomatic PH is usually much higher, often two to three times those thresholds, so numbers are entry criteria not clinical reality.
Think Primary Versus Secondary Pulmonary Hypertension
- PH is classified into five major categories for specialists but clinically think first: is it venous/arterial primary or secondary to another obvious process?
- Davy highlights category one (PAH) vs category two (left heart disease) as the key clinical divider for initial approach.
Always Rule Out Left Heart Disease First
- Always consider left heart disease first when you find PH because raised left atrial pressure commonly raises pulmonary pressures.
- Check for aortic valve disease, myocardial disease, and mitral valve disease as common culprits.