Current diagnostic and prognostic assessment of pulmonary Hypertension.

Recently, our view of pulmonary hypertension has been changed by the significant progress made in understanding the pathobiology, epidemiology and prognosis of the disease. The increasing number of different conditions now associated with pulmonary hypertension and the appearance of new diagnostic techniques have led to a need for a systematic diagnostic approach and a new disease classification. This review article presents an update on developments in the epidemiology and pathobiology of pulmonary hypertension, on changes in the clinical classification of the disease, and on alterations in the diagnostic algorithm. In addition, it contains detailed descriptions of the treatment recommended for patients in whom an elevated systolic pulmonary pressure is discovered on echocardiography, of the differential diagnosis of pulmonary arterial hypertension and pulmonary hypertension associated with left heart disease, and of multifactorial approaches to determining prognosis, which are three of the most actively debated topics today. Finally, a care program for patients with pulmonary arterial hypertension is proposed.

Evaluación diagnóstica y pronóstica actual de la hipertensión pulmonar / Current diagnostic and prognostic assessment of pulmonary hypertension

Recientemente se han producido importantes avances en el conocimiento de la biopatología, la epidemiología y el pronóstico de la hipertensión pulmonar que han cambiado la perspectiva de la enfermedad. El número creciente de enfermedades asociadas a la hipertensión pulmonar y la aparición de nuevas técnicas diagnósticas obligan a sistematizar el procedimiento diagnóstico y definir una clasificación. En esta revisión se actualizan las principales novedades en epidemiología y patobiología, las modificaciones en la clasificación clínica y los cambios en el algoritmo diagnóstico. Se desarrolla con detalle el manejo recomendado del hallazgo de presión sistólica pulmonar elevada en el ecocardiograma, el diagnóstico diferencial entre hipertensión arterial pulmonar e hipertensión pulmonar asociada a cardiopatía izquierda y la valoración multifactorial del pronóstico, que forman parte de los aspectos más controvertidos actualmente. Finalmente, se propone una organización asistencial para los pacientes con hipertensión arterial pulmonar (AU)

Recently, our view of pulmonary hypertension has been changed by the significant progress made in understanding the pathobiology, epidemiology and prognosis of the disease. The increasing number of different conditions now associated with pulmonary hypertension and the appearance of new diagnostic techniques have led to a need for a systematic diagnostic approach and a new disease classification. This review article presents an update on developments in the epidemiology and pathobiology of pulmonary hypertension, on changes in the clinical classification of the disease, and on alterations in the diagnostic algorithm. In addition, it contains detailed descriptions of the treatment recommended for patients in whom an elevated systolic pulmonary pressure is discovered on echocardiography, of the differential diagnosis of pulmonary arterial hypertension and pulmonary hypertension associated with left heart disease, and of multifactorial approaches to determining prognosis, which are three of the most actively debated topics today. Finally, a care program for patients with pulmonary arterial hypertension is proposed (AU)

Embolismo paradójico a través de un foramen oval permeable en un paciente que desarrolló un tromboembolismo pulmonar masivo / Paradoxical embolism through a patent foramen ovale in a patient that developed massive pulmonary thromboembolism

El embolismo paradójico tiene lugar cuando material embolígeno que procede del sistema venoso o del lado derecho del corazón llega a la circulación arterial sistémica, sin pasar por el filtro capilar pul monar. Se presenta un caso de embolia arterial paradójica a través de un foramen oval permeable no conocido previamente, en un paciente que desarrolló un tromboembolismo pulmonar masivo. Se aportan los hallazgos radiológicos en tomografía computarizada, eco-Doppler y arteriografía, que fueron cruciales en el diagnóstico precoz de este raro proceso patológico

Paradoxical embolism occurs when embologenic material from the venous system or right heart reaches the systemic arterial circulation without being filtered out by the capillaries of the lungs1. We present a case of paradoxical arterial embolism through a previously undiscovered patent foramen ovale in a patient who developed massive pulmonary embolism (PTE). We describe the findings at computed tomography (CT), Doppler ultrasound, and arteriography, which were crucial in establishing the early diagnosis of this rare pathologic process