Pulmonary hypertension associated with left heart diseases (clinical case)
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Abstract
This paper presents clinical case of pulmonary hypertension associated with left heart diseases (PH-LHD) in 63 year old woman with heart failure and preserved ejection fraction (HFpEF). The history of disease (arterial hypertension, atrial fibrillation, diabetes mellitus, acute pulmonary embolism, obesity, chronic obstructive lung disease) and results of standard investigations (no signs of thrombi in pulmonary arteries, significant enlargement of right heart and normal size of left heart, high level of calculated systolic blood pressure in pulmonary artery, high level of B-type natriuretic peptide) did not help to classify the type of pulmonary hypertension (PH). Only after right heart catheterization it was possible to state right diagnosis – post capillary combined PH-LHD. There are also discussed the latest guidelines in diagnosis and treatment of HFpEF and PH-LHD. Some considerations in favor of new step algorithm for diagnosis of HFpEF that was proposed by European Cardiology Congress in Paris (2019) were done and there was demonstrated its possible use in Ukraine. Some questions of morphological and pathogenic differences between precapillary pulmonary arterial hypertension (PAH) and post-capillary PH-LHD were discussed. Conclusion about not using of specific PAH therapy in PH-LHD patients was based on some arguments. There are elucidated some drug interventions in patients with HFpEF. Especial emphasized the necessity of risk factor and concomitant state corrections, including life style modification and non-drug treatment.
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