Making measurements in the pulmonary circulation: when and how?

Primary pulmonary hypertension is a well known though in patients with persistent hypoxaemia (Pa2 <7.3 kPa) who complain of deteriorating exercise tolerance in the rare condition, but pulmonary hypertension also occurs as a consequence of most heart and lung diseases where it is face of static spirometric values, or in those who develop evidence of fluid retention. This can be a difficult clinical largely unrecognised and untreated and is therefore a major clinical challenge. The consequence of this failure to assess diagnosis and one American study noted that up to 30% of admissions to hospital with a diagnosis of congestive the pulmonary circulation is that the process may progress to the point where treatment is less likely to be beneficial. cardiac failure actually had fluid retention associated with pulmonary hypertension. It is because the symptoms and signs of pulmonary hypertension are often rather vague and non-specific that it There is little doubt that secondary pulmonary hypertension is an important factor in the morbidity and is important to be aware of methods of measurement in the pulmonary circulation and their sensitivity, specificity, mortality of chronic hypoxic lung disease and other conditions. Quantifying pulmonary haemodynamics should be and relative merits. There is no easily applied sphygmomanometer for the pulmonary circulation, but there are a an important part of assessment of these patients and can assist us in future decisions about the success or otherwise number of techniques – both invasive and non-invasive – which can help us to make the diagnosis. Implicit in the of treatment directed both at the primary respiratory disease and at the pulmonary circulation itself. Clearly, the first desire to make an earlier diagnosis of pulmonary hypertension is the belief that there is some point in doing therapeutic objective must be the treatment of the pulmonary condition, but we should be monitoring the effects so – that is, that the condition is itself of significance and that we may be able to offer some additional treatment to of this treatment and the use of vasodilators, if appropriate, on the pulmonary circulation. the patient.